Splenic Trauma: should we treat differently?

A 36 year old male was admitted to Accident and Emergency Department following a motor vehicle accident. Clinical examination revealed a haemodynamically stable patient. Abdominal examination showed tenderness in right upper quadrant. Ultrasonography of the abdomen was normal. Haemoglobin on admission was 13 gm/dl. A repeated haemoglobin six hours later revealed a Hb of 10 gm/dl. Computerized tomography(CT) of the abdomen showed a ruptured spleen. As the patient was haemodynamically stable, it was decided to treat the patient in the HDU setting. His condition remained stable and he was fit to be discharged home on the fifth post-operative day. Introduction ‘’Medicine is not an exact science. Treatment modalities change according to the limits of the time.’’ This statement is nowhere so appropriate as in the case of splenectomy following trauma. Zacarello performed the first splenectomy in 1549. However, splenectomy following trauma became more common in the 20th century with the introduction of the motor vehicle. The large number of patients who develop Overwhelming Post Splenectomy syndrome (OPSS) after splenectomy made splenic conservation an important consideration and the first partial splenectomy was performed in the 19th century. However this conservative approach only gained favour a century later. In this paper we would like to report a case of nonoperative treatment of splenic trauma locally and discuss the management of this condition.