title: Non-operative management and immune function after splenic injury.
abstract: BACKGROUND
  There is still considerable controversy about the importance and method of preserving splenic function after trauma. Recognition of the immune function of the spleen and the risk of overwhelming postsplenectomy infection led to the development of spleen-preserving surgery and non-operative management. More recently angiographic embolization has been used to try to reduce failure of conservative management and preserve splenic function.
  
  
  METHODS
  A literature review was performed of the changing treatment of splenic injury over the last century, focusing on whether and how to maintain splenic immune function.
  
  
  RESULTS
  Non-operative management continues to be reported as a successful approach in haemodynamically stable patients without other indications for laparotomy, achieving high success rates in both children and adults. Except for haemodynamic instability, reported predictors of failure of conservative treatment should not be seen as absolute contraindications to this approach. Angiographic embolization is generally reported to increase success rates of non-operative management, currently approaching 95 per cent. However, the optimal use of angioembolization is still debated. Splenic immunocompetence after angioembolization remains questionable, although existing studies seem to indicate preserved splenic function.
  
  
  CONCLUSIONS
  Non-operative management has become the treatment of choice to preserve splenic immune function. Current knowledge suggests that immunization is unnecessary after angiographic embolization for splenic injury. Identifying a diagnostic test of splenic function will be important for future studies. Most importantly, in efforts to preserve splenic function, care must be taken not to jeopardize patients at risk of bleeding who require early surgery and splenectomy.
authors.affiliation: Department of Traumatology, Division of Emergency and Critical Care, Oslo University Hospital, N-0407 Oslo, Norway.
authors.forename: J
authors.initials: J
authors.lastname: Skattum
authors.forename: P A
authors.initials: PA
authors.lastname: Naess
authors.forename: C
authors.initials: C
authors.lastname: Gaarder
mesh_terms: D004621:Embolization, Therapeutic / Q000379:methods*; D006801:Humans; D007113:Immunity, Innate / Q000502:physiology*; D059351:Organ Sparing Treatments / Q000379:methods; D013154:Spleen / Q000276:immunology / Q000293:injuries*; D017211:Treatment Failure; D014949:Wounds, Nonpenetrating / Q000276:immunology / Q000628:therapy*