Spontaneous splenic rupture: an unusual cause of hypovolaemia.

Birkinshaw, R; Saab, M; Gray, Alasdair

doi:10.1136/emj.13.4.289

Cited by 3 publications

(2 citation statements)

References 5 publications

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“…12,21,23,25,27 However, there are clear differences in the underlying architecture of an otherwise normal traumatically injured spleen and that of a patient with IM and associated SSR, which, in addition to being grossly enlarged and abnormal and taking longer to heal, 23 may also contain large subcapsular hematomas, which are prone to delayed rupture. 28 Given the associated risks of nonoperative management, which include those of acute and ongoing (or delayed) hemorrhage, blood transfusions, extended hospitalization, and significant and long-term activity restriction, all of which may outweigh the risks of sepsis after splenectomy, 12,29 many authors urge caution with this approach and continue to favor emergency splenectomy followed by postinfectious prophylaxis in all patients with IM and splenic rupture. 7,13,30,31 Prevention and Outpatient Management…”

Section: Spontaneous Splenic Rupturementioning

confidence: 97%

Spontaneous Splenic Rupture in Infectious Mononucleosis

Rinderknecht

Pomerantz

2012

Pediatric Emergency Care

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A 15-year-old previously healthy girl presented in full arrest after 1 week of flu-like symptoms, recent diagnosis of infectious mononucleosis, and 1 day of abdominal pain. There was no history of trauma. Focused assessment with sonography for trauma examination showed free fluid in the abdomen. The patient died despite aggressive resuscitative management and emergency laparotomy with splenectomy, which showed grade V splenic laceration. Infectious mononucleosis is a common viral illness of adolescence. Spontaneous splenic rupture is a rare but potentially fatal complication. Anticipatory guidance about the importance of seeking medical care if abdominal pain develops during infectious mononucleosis is crucial to early diagnosis and intervention in the case of rupture. We discuss the current literature surrounding the outpatient follow-up of splenomegaly associated with infectious mononucleosis, as well as current practice and treatment options when rupture occurs. I nfectious mononucleosis (IM) is most commonly caused byEpstein-Barr virus (EBV), a member of the herpes group. 1 In the United States, symptomatic disease peaks in incidence between 15 and 24 years of age and affects up to 3% of college students each school year. 2Y4 Most cases of IM are self-limited, and patients return to school and activities within 2 to 4 weeks. Splenomegaly is a well-known associated finding during the course of IM, occurring in approximately 50% of patients. 5Y9 However, only a minority of patients with splenomegaly report abdominal pain, and even fewer have severe complications such as splenic rupture. Splenic rupture is the most common potentially fatal complication of IM and has been estimated to occur in 0.1% to 0.2% of all cases. 3, 9Y11 We present a case of a patient with a diagnosis of IM who developed abdominal pain and subsequently presented in cardiac arrest from spontaneous splenic rupture (SSR) to highlight the importance of anticipatory guidance regarding this particular symptom. We also discuss the outpatient management of IM with splenomegaly as well as current management considerations in the event that splenic rupture occurs. CASEA 15-year-old female patient with no significant medical history presented to the pediatric emergency department (ED) in cardiac arrest. She had been ill for several days and, on the day before presentation, had been diagnosed with IM by her primary care provider. During the evening and night before presentation, she had reportedly developed abdominal pain and had been taking acetylsalicylic acid for pain control. The morning of presentation, she complained of abdominal pain and weakness and collapsed at home shortly after calling 911. There was no known history of trauma. On arrival of emergency medical service providers, she was still talking but deteriorated and went into cardiac arrest en route to the hospital. She was taken to a community ED where she was intubated. Access was established with 2 intraosseous lines, and she underwent cardiopulmonary resuscitation with brief and i...

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Section: Spontaneous Splenic Rupturementioning

confidence: 97%

Spontaneous Splenic Rupture in Infectious Mononucleosis

Rinderknecht

Pomerantz

2012

Pediatric Emergency Care

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“…43,70,83,93,101,126,129]: six had been admitted with signs of irreversible circulatory shock; the other three died after initial fluid resuscitation and urgent splenectomy. Fatal cases were temporally distributed as follows: 0 in1970-1979, 2 in 1980-1989, 4 in 1990-1999, 1 in 2000-2009 and 2 in 2010-2022.…”

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confidence: 99%

Splenic rupture or infarction associated with Epstein-Barr virus infectious mononucleosis: a systematic literature review

Toti,

Gatti,

Hunjan

et al. 2023

Swiss Med Wkly

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BACKGROUND: Epstein-Barr virus (EBV), also known as human herpesvirus 4, is one of the most common pathogenic viruses in humans. EBV mononucleosis always involves the spleen and as such it predisposes to splenic rupture, often without a trauma, and splenic infarction. Nowadays the goal of management is to preserve the spleen, thereby eliminating the risk of post-splenectomy infections. METHODS: To characterise these complications and their management, we performed a systematic review (PROSPERO CRD42022370268) following PRISMA guidelines in three databases: Excerpta Medica, the United States National Library of Medicine, and Web of Science. Articles listed in Google Scholar were also considered. Eligible articles were those describing splenic rupture or infarction in subjects with Epstein-Barr virus mononucleosis. RESULTS: In the literature, we found 171 articles published since 1970, documenting 186 cases with splenic rupture and 29 with infarction. Both conditions predominantly occurred in males, 60% and 70% respectively. Splenic rupture was preceded by a trauma in 17 (9.1%) cases. Approximately 80% (n = 139) of cases occurred within three weeks of the onset of mononucleosis symptoms. A correlation was found between the World Society of Emergency Surgery splenic rupture score, which was retrospectively calculated, and surgical management: splenectomy in 84% (n = 44) of cases with a severe score and in 58% (n = 70) of cases with a moderate or minor score (p = 0.001). The mortality rate of splenic rupture was 4.8% (n = 9). In splenic infarction, an underlying haematological condition was observed in 21% (n = 6) of cases. The treatment of splenic infarction was always conservative without any fatal outcomes. CONCLUSIONS: Similarly to traumatic splenic rupture, splenic preservation is increasingly common in the management of mononucleosis-associated cases as well. This complication is still occasionally fatal. Splenic infarction often occurs in subjects with a pre-existing haematological condition.

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