Criteria for conservative management:
(1) hemodynamically stable (normotensive with stable pulse)
(2) no signs of clinical deterioration (clinically stable)
(3) stable hemoglobin with <= 2 units of blood transfused
(4) compliant with bed rest
where:
• The time period over which the blood is transfused is not stated.
• According to Hamel et al, spontaneous rupture of the spleen is more of a problem for Plasmodium vivax infections.
Features of conservative management:
(1) scrupulous bed rest for several weeks, until completely resolved
(2) careful monitoring
(3) periodic CT scans to monitor resolution of injury or to detect expansion
(4) access to emergency services if signficant rupture occurs
Delayed rupture may occur with medical management, especially if the conservative management is stopped too soon.
If surgery is required, then surgical repair or partial resection should be tried, with complete splenectomy performed only when all else fails.
