Background: Portal hypertension is the fate of chronic forms of schistosomiasis, and manifests with splenomegaly and portosystemic collaterals. Patients with schistosomal splenomegaly are vulnerable to higher grades of splenic injury when subjected to blunt abdominal trauma. Defective hemostasis together with compromised general status of the patient may interfere with management of these cases. Aim of this study was to assess management of splenic injury in cases of blunt abdominal trauma in cases of schistosomal splenomegaly. Methods: The study included 165 patients admitted with blunt abdominal trauma. They were divided into two groups “Group A” (30 patients) with schistosomal splenomegaly and “Group B” (135 patients) as a control. The data were retrospectively reviewed as regards incidence and grade of splenic injury and management of included cases. Results: Splenic injury occurred in 28 patients (93.34%) in “Group A” and in 18 patients (13.34%) in “Group B” (P0.001). Among patients with splenic injury, there were significant advanced grades of injury in “Group A” than “Group B” (P=0.003). “Group A” showed significant more need for blood transfusion than “Group B” (P0.001). Conservative management was not successful for any of the cases of “Group A” while it was successfully applied in (66.67%) of “Group B” (P0.001). Splenectomy was performed in all the explored cases in Group A. Conclusions: Splenic injury following blunt abdominal trauma in cases of schistosomal splenomegaly should be managed as a special entity. Our recommendation is to proceed for abdominal exploration in such cases and splenectomy is the treatment of choice. Keywords: Blunt abdominal trauma; Schistosomal splenomegaly; Splenic injury.