Trauma to the spleen.

After blunt abdominal trauma the diagnosis of splenic injury is usually made on clinical grounds, with the addition of peritoneal lavage where doublt exists about intraperitoneal injury or severe head or spinal trauma complicates the picture,.(Powell & Bivins, 1982). Decisions about management are often taken on clinical grounds alone with confirmation of the diagnosis being obtained at operation or by later use of radiological imaging. (Mishalang & Miller, 1982). There seems little doubt that the accuracy of diagnosis in the acutely injured patient could be improved in many areas by the provision of trauma centres containing computerized tomographic facilities on a 24-h basis (Alexander & Clark, 1982). Doctors seem to have caught the political disease of concerning themselves more about cost than quality in failing to lobby for this type of development. Faced with the problem of suspected splenic injury, surgeons are currently managing patients who a mere 10 years ago would have been subject to splenectomy by a variety of techniques which aim to conserve splenic tissue and splenic function. Awareness of the dangers following splenectomy in children led many children's surgeons to respond by treating these injuries more conservatively with great success. Reports which indicated similar dangers to the asplenic adult then led to further interest in splenic conservation, with the emphasis on operative repair of the organ or autotransplantation of free grafts rather than non-surgical treatment. Splenic conservation in children is undoubtedly safe and has been practised in many centres for several decades. Splenic isotope scanning, or computed tomography, confirms the injury and its resolution with both methods, giving accurate diagnosis in