An analysis of 106 adult patients with blunt multiple organ injury and splenic trauma was carried out during an eight year period. Three groups were studied--group 1, splenectomy; group 2, splenorrhaphy, and group 3, observation. There was no statistically significant difference in initial blood pressure, pulse or hematocrit among the three groups. The mean injury severity score (ISS) was higher for those in groups 1 and 2 (26.8 and 25.6, respectively) versus patients in group 3 (17.9) (p). There were a total of 38 intra-abdominal injuries in 34 patients of which 21 required surgical repair. No patient in the nonoperative group required laparotomy for a missed associated intra-abdominal injury. There were a total of 15 intra-abdominal complications related to splenic management. In the observation group, seven patients ultimately required laparotomy for continued splenic bleeding. In the splenorrhaphy group, the complication rate was significantly lower versus the other two groups (p). We concluded that, if technically feasible, splenorrhaphy is a safe procedure in the multiply injured patient in the absence of hypotension and coagulopathy. Nonoperative management of blunt splenic trauma should be viewed with caution because of the high failure rate in the multiply injured patient.