Selective non-operative management of abdominal visceral lesions is one of the most important and challenging changes that occurred in trauma patient care over the last 20 years. The main advantage of this type of management is the avoidance of unnecessary/non-therapeutic laparotomies. Trauma surgeons who deal with this type of treatment are worried of missed abdominal injuries. Modern diagnostic tools (spiral computed tomography, ultrasound, angiography, laparoscopy) allow trauma surgeons to accurately characterize the lesions to be addressed non-operatively. This presentation discusses the main elements of selective, non-operative management of principle solid visceral lesions (liver, spleen, and kidney). The advantages and limitations of the main diagnostic instruments used for evaluation of trauma patients allocated to non-operative management will be highlighted. Polytrauma patients in a Leve-1 trauma center over the last five years were selected and outcomes were analyzed. Pancreatic trauma remains an operative injury. However, surgeons must temper the enthusiasm for non-operative management of patients with solid organ injury, and exclude patients who would best be treated with surgery from this management scheme. Emergency care of the patients according the golden hour and team ability must be considered.