Conservative Management of Ruptured Spleen

For many years it was accepted that splenic injury was best managed by splenectomy. However, it has more recently been realized that patients whose spleen has been removed are more liable to life-threatening infec­ tion. This is of particular consequence if splenectomy is performed in childhood, with a long life expectancy. The extra mortality rate associated with sepsis after splenectomy is noted from reports in the literature, and the immunological functions of the spleen are discussed. It is pointed out that with the present diagnostic means splenic rupture or splenic injury need not necessarily indicate splenectomy. The features of conservative man­ agement are outlined, and the results in 75 patients, of whom only 21 underwent splenectomy, are stated. S. AII'. med. J., 57, 655 (1980). Until tbe turn of tbe century, splenic injuries were usually managed without operation, generally with disastrous results. The'mortality was close to 100%, and it was this figure that led to the widespread acceptance of splenec­ tomy wbich dramatically reduced mortality. ot only is the operation of splenectomy fairly straight­ forward but it is the sort of operation most surgeons enjoy doing. The anatomy is not difficult to memorize, the organ is easy to identify, and its removal, provided the incision is of adequate size, is really quite easy. Indeed, the larger the spleen the easier the splenectomy. True, it is possible to damage the tail of the pancreas, the greater curvature of the stomach, or even the