Injury to the spleen is one of the more serious problems associated with trauma. Emergently there is the possibility of exsanguination. However, for the remainder of the patient's life after splenectomy, there is the possibility of catastrophic bacterial infection with encapsulated organisms, such as pneumococci, especially in the very young. This has stimulated clinicians to conserve the spleen with or without operation. Nonoperative treatment in children is often successful if careful monitoring is provided in-hospital and thereafter at home until full healing is documented. Additionally, in adults as well as in children, splenorrhaphy is often possible, as it is desirable to salvage as much of the traumatized spleen as possible. It is uncertain how much retained spleen is essential to provide normal protection for the patient, but many recommend preservation of half or more if possible. The surgeon must appreciate that it is essential to control exsanguination and that total splenectomy should be performed for splenic fractures that are massive or that cannot be easily controlled in the presence of continued major hemorrhage.