Objectives: The purpose of this study was to estimate the role of initial hemodynamic stabilization in patients with hemoperitoneum after trauma. Methods. A prospective study focused on 70 trauma patients with blunt spleen trauma managed non-operatively over 5 years (2007-2011) in the surgical service of NCEM. The patients were reviewed for the following information: age, Injury Severity Score (ISS), American Association for the Surgery of Trauma splenic injury grade (SIG), systolic blood pressure (systolic BP). Results: Out of the total number of patients, 65.7% were male, mean age of 39.7±4.1. SIG ≥ III was present in 48.6% of cases. Twenty patients (or 28.6%) had isolated spleen trauma and 50 (or 71.4%) presented associated injuries. Out of the total, 57 patients were hemodynamically stabile (ISS=21.7±1.13). The balance of 13 patients (or 18.6%) showed an ISS of 37.8±2.59 and a systolic BP<90 mmHg at admision. They received volume replacement for stabilization. In the hemodynamically unstable group only one patient (or 7.7%) had isolated blunt spleen trauma, that four hours interval from admission developed fall in blood pressure and was managed by an urgent operation (ISS=25, SIG IV). The severity of spleen injury at the hemodynamically unstable patients was as follows: SIG I (n=1), SIG II (n=4), SIG III (n=5) and SIG IV (n=2). Conclusions: The injuries associated to blunt spleen trauma could point on an origin of blood loss and hemodynamic instability other than hemoperitoneum. Early volume replacement and stabilization of blood pressure offers the opportunity to avoid laparotomy without increasing the risk in polytrauma patient and afford non-operative management when the hemodynamic stability is achieved.