title: Non-operative treatment approach for blunt splenic injury: is grade the unique criterion?
abstract: BACKGROUND
  We aimed to investigate the results of a non-operative approach to blunt spleen injury to re-evaluate the importance of injury grade.
  
  
  METHODS
  Thirty-one blunt splenic trauma cases subjected to non-operative treatment were evaluated retrospectively. The patients were classified into two groups as isolated spleen trauma (ST) group and multi-trauma (MT) group. The hospitalization and blood replacement needs, success of non-operative follow-up, and post-traumatic complications were compared between the two groups. The patients were evaluated via follow-up abdominal ultrasonography (US) and computerized tomography (CT). The results were evaluated with regard to post-splenic trauma complications.
  
  
  RESULTS
  According to the organ injury scale of the American Association for the Surgery of Trauma, 25.8% were grade-1, 32.2% grade-2, 29% grade-3, and 12.9% grade-4 injuries. It was observed that the transfusion amount was directly proportional to the injury grade. All patients with grade-4 injury and 14 patients with MT were treated successfully with the non-operative method. Splenic pseudoaneurysm developed in one patient in the MT group. One patient was diagnosed with late splenic rupture.
  
  
  CONCLUSIONS
  Hemodynamic stability is the most important criterion for the indication of non-operative treatment. However, in well-selected cases, patients with grade 4 splenic traumas and those with extra-splenic injuries could also be treated successfully with the non-operative method.
authors.affiliation: Department of General Surgery, Ondokuz Mayıs University Faculty of Medicine, Samsun, Turkey.
authors.forename: Bülent
authors.initials: B
authors.lastname: Koca
authors.forename: Koray
authors.initials: K
authors.lastname: Topgül
authors.forename: Saim Savaş
authors.initials: SS
authors.lastname: Yürüker
authors.forename: Hamza
authors.initials: H
authors.lastname: Cınar
authors.forename: Bekir
authors.initials: B
authors.lastname: Kuru
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000792:Angiography; D001803:Blood Transfusion; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013154:Spleen / Q000000981:diagnostic imaging / Q000293:injuries*; D014463:Ultrasonography; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging / Q000628:therapy*; D055815:Young Adult