Recognition of the important functions of the spleen in children led to nonoperative methods for the management of spleen injuries more than 2 decades ago. Improvements in computed tomography and, more recently, ultrasound techniques for the detection of intra-abdominal bleeding and organ injury have joined with improved monitoring and critical care to make nonoperative management of most spleen and liver injuries in patients of all ages a clinical reality. Advanced interventional radiology procedures are now available, which offer ways to stop bleeding and deal with postinjury abscesses and fluid collections. That nonoperative therapy of spleen injuries is one of the accepted standards of spleen injury care is an unassailable truth. On the other hand, the article by Velmahos and colleagues serves to remind us that our knowledge is not complete regarding spleen injuries, and that dangerous failures of management can occur. The failure rate and the patterns of failure have been nagging, troublesome questions for clinicians dealing with spleen injuries in adults. Higher injury grade, a large volume of extrasplenic blood seen on computed tomographic scan, comorbid diseases, and the need for transfusion are factors statistically predictive of the failure of nonoperative management, and this has been confirmed by Velmahos and coauthors.
Flint L. Nonoperative Management of Splenic Injuries—Invited Critique. Arch Surg. 2000;135(6):681. doi:10.1001/archsurg.135.6.681