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The remaining patient (11%) - who had tubeless PCNL without postop imaging presented five days postoperatively with a delayed bleed and underwent emergent splenectomy. Seven of the nine (78%) were successfully managed non operatively and without need for transfusion or embolization. CONCLUSION The majority of patients incurring splenic injury during PCNL can be successfully managed conservatively with maintenance of nephrostomy tube for two days or greater. Consequences of unrecognized splenic injury may include splenic bleed a