Injury to the spleen occurs commonly from blunt mechanisms in both adults and children. With improving safety of splenectomy in the mid 20th century, splenectomy was the only operative option, even for trivial injury to the spleen. As our understanding of splenic anatomy matured and the risk of OPSI was elucidated, operative salvage of the spleen became the preferred treatment. Prompted by initial reports in children, and later in adults, nonoperative treatment has become the common pathway to splenic conservation. Children infrequently require laparotomy for injury to the spleen; observation of the injury to the spleen is successful in more than 90% of children. On the basis of the current literature, one third of adults with blunt injury to the spleen require laparotomy because of hemodynamic instability. Of adults who were treated nonoperatively, the risk of failure is currently reported to be 8% to 10%. Careful patient selection is critical for the safe observation of blunt injury to the spleen.
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