XXXX in adults: selective nonoperative management.

@entity1 @entity4558 @entity130
Although nonoperative management is the standard initial treatment in @entity1 with @entity130 , this therapeutic option has been exercised infrequently in adults. Over the past two years we have hospitalized and observed 11 hemodynamically stable adults with @entity130 and no other significant injury. Ten @entity1 sustained @entity130 localized to the left upper quadrant, and one @entity1 was stabbed in the left flank. Eight @entity1 were normotensive on hospital arrival, while three had an initial systolic blood pressure of 90 to 98 mm Hg. All @entity1 remained normotensive after receiving 2 liters of crystalloid fluid IV. Nine @entity1 had an initial hemoglobin level of 11.1 to 14.0 gm/dl, and two a level of less than 10 gm/dl. Liver-spleen scan done in ten @entity1 yielded true-positive results in eight, false-positive results in one, and false-negative results in one. In the 11th @entity1 , a celiac arteriogram showed a @entity4558 . Three @entity1 had laparotomy 27 to 43 hours after hospitalization, owing to a decreasing hemoglobin concentration; one required partial splenectomy. Eight @entity1 were successfully managed nonoperatively; only one required blood transfusion, and all tolerated oral alimentation by the second hospital day. All @entity1 were discharged by the 12th hospital day. Nonoperative management can be successfully applied to adults with isolated @entity130 .
