Nonoperative Management of Spontaneous Splenic Rupture in Infectious Mononucleosis: A Case Report and Review of the Literature

Abstract

Spontaneous rupture of the spleen is a rare complication of infectious mononucleosis with no clear consensus on appropriate management. Although management of traumatic splenic rupture has largely moved to nonoperative treatment, splenectomy is still frequently used in dealing with rupture of the diseased spleen. Here we report the case of a 16-year-old boy with splenic rupture secondary to laboratory-confirmed infectious mononucleosis in the absence of trauma. Nonoperative management including ICU admission, serial computed tomography scans, and activity limitation was used successfully. Our experience, along with a review of the literature, leads us to conclude that splenic preservation can be a safe alternative to splenectomy in hemodynamically stable patients with spontaneous splenic rupture. This is of particular importance in the pediatric population, which is at higher risk for postsplenectomy sepsis.

Spontaneous Splenic Rupture Following Bouts of Coughing: A Rare Case Report and Literature Review

“…Rupture usually occurs during the first week although delayed rupture cases are well documented [35]. Stephenson and DuBois showed in a recent report that patients requiring less than 4 U or 40 mL/kg of PRBC for resuscitation can be managed conservatively [36]. However, each patient should be assessed on an individual basis with low threshold for surgical intervention in the context of any change in hemodynamic status of the patient.…”

Non-surgical management of spontaneous splenic rupture in infectious mononucleosis

“…Other complications associated with splenectomy include pancreatitis, pneumonia, pulmonary embolism, and a higher rate of wound infections. 7 The question that still must be answered to ensure that non-operative management is as safe and effective as splenectomy is whether the diseased spleen can heal and retain its immunologic function. Splenomegaly has long been recognized as a complication of infectious mononucleosis (IM) and other infectious conditions and is known to be a self-limited condition.…”

Spontaneous splenic rupture during a cytomegalovirus primoinfection

“…Dans les RSR d'origine infectieuse, il est encore sujet à débat vu la rareté des cas et la présence d'une rate pathologique. Dans le cadre de la MI, Stephenson et al recommandent un traitement conservateur pour les patients qui requièrent moins de quatre culots globulaires ou 40 ml/kg de sang pour leur réanimation [14]. Au terme d'une revue de la littérature à propos des RSR secondaires à une primo-infection à CMV, Maillard et al concluent que la gestion non opératoire est une conduite sûre dans la prise en charge des patients initialement stables sur le plan hémodynamique [1].…”

“…Cette attitude est d'une importance particulière dans la population pédiatrique du fait d'un risque élevé de développer un sepsis postsplénectomie [14]. En cas de traitement conservateur, une limitation de l'activité est recommandée, la marche est la seule activité permise jusqu'à disparition de la spléno-mégalie.…”