Rupture of the pathologic spleen: is there a role for nonoperative therapy?
BACKGROUND
While nonoperative management of blunt splenic injury in the stable patient has become the standard of care, splenectomy is still advocated as the safest management for rupture of the diseased spleen. The combination of splenectomy and underlying immunosuppression may render these patients particularly susceptible to postsplenectomy infection, and thus we undertook a prospective trial of nonoperative management of the ruptured pathologic spleen.


METHODS
Hemodynamically stable patients with preexisting pathologic splenomegaly and isolated splenic disruptions diagnosed by computed tomographic (CT) scan (American Association for the Surgery of Trauma (AAST) grades 1-4) requiring 2 or less units blood transfusion were prospectively studied. Patients were monitored in a critical care setting, and resolution of splenic disruption was followed by serial CT examinations.


RESULTS
Nonoperative management was successful in all 11 patients (eight, HIV/AIDS; one each, acute leukemia, infectious mononucleosis, sickle cell anemia). The mean transfusion requirement was 0.7 units; the mean length of stay was 16 days.


CONCLUSIONS
The pathologic spleen can heal after parenchymal disruption. While not appropriate for all patients, a subset of hemodynamically stable patients can be successfully managed nonoperatively using CT diagnosis, close clinical monitoring, and minimal transfusions.
Guth
A A
AA
Bellevue Hospital Center, New York University Medical Center, New York, New York 10016, USA.
Pachter
H L
HL
Jacobowitz
G R
GR
D000328:Adult; D000368:Aged; D006679:HIV Seropositivity / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012422:Rupture, Spontaneous; D013161:Splenic Rupture / Q000209:etiology / Q000628:therapy*; D013163:Splenomegaly / Q000150:complications* / Q000628:therapy; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000628:therapy*