The risk of overwhelming postsplenectomy infection (OPSI) prompted the evolution toward preservation of the injured spleen. Nonoperative management (NOM) of blunt injury to the spleen in adults has become the standard of care in hemodynamically stable patients. This modality of treatment began in the 1970’s in paediatric patients. It is highly successful with overall failures rates from 2% to 31% (average 10.8%) – with the majority of failures occurring in the first 24 hours. Current, NOM of splenic trauma includes splenic artery embolization.

However, the criteria for NOM are controversial. In this study we present the current criteria, the evolution and failure rates of this type of management viewed through the general knowledge and, particularly, our experience.