Spontaneous splenic rupture in infectious mononucleosis

Rothwell, Sean; McAuley, Duncan

doi:10.1046/j.1035-6851.2001.00241.x

Cited by 15 publications

(12 citation statements)

References 11 publications

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“…Nonoperative management of splenic rupture in a stable trauma patient is considered standard of care, especially in pediatric patients, who are at increased risk of postsplenectomy sepsis. 12,18 Many practitioners report success with conservative management (including observation, somatostatin infusion, and endovascular interventional modalities) in patients with IM-related SSR who are hemodynamically stable and have minimal transfusion requirements. 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.…”

Section: Spontaneous Splenic Rupturementioning

confidence: 98%

“…12,18 Many practitioners report success with conservative management (including observation, somatostatin infusion, and endovascular interventional modalities) in patients with IM-related SSR who are hemodynamically stable and have minimal transfusion requirements. 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.…”

Section: Spontaneous Splenic Rupturementioning

confidence: 98%

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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: 98%

Section: Spontaneous Splenic Rupturementioning

confidence: 98%

Spontaneous Splenic Rupture in Infectious Mononucleosis

Rinderknecht

Pomerantz

2012

Pediatric Emergency Care

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“…These are generally grouped in the categories of infectious diseases (e.g. infectious mononucleosis 4,5 , malaria 6 and dengue 7 ), splenic neoplasms 8,9 and haematological malignancies 10,11 . Another condition occasionally associated with splenomegaly is haemophilia 12,13 .…”

Section: Discussionmentioning

confidence: 99%

“…Splenic rupture, if unidentified, carries a significant morbidity and mortality 4 . This is significantly increased in haemophilia, where the normal clotting systems that might otherwise buy time for a surgeon are impaired 30 .…”

Section: Discussionmentioning

confidence: 99%

Splenectomy in severe haemophilia

Caldicott

Bonnin

Lloyd

et al. 2004

ANZ Journal of Surgery

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“…The diagnosis of spontaneous splenic rupture should be entertained in young patients with acute atraumatic abdominal pain who have symptoms suggesting a recent viral syndrome. 8,9 Spontaneous splenic rupture from infectious causes has been described most often in association with Epstein-Barr virus (EBV), cytomegalovirus, toxoplasmosis and acute HIV infection. Other causes include lymphoma and lymphoproliferative diseases, solid neoplasms, aneurysm, pancreatitis, dengue fever, Q fever, typhoid fever and malaria.…”

Section: Spontaneous Splenic Rupturementioning

confidence: 99%

Unusual case of acute onset abdominal pain: uses and limitations of medical imaging

Bandıera

Poulin

2003

CJEM

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A 28-year-old male with atraumatic abdominal pain and transient hypotension was assessed using bedside emergency department (ED) ultrasonography and contrast enhanced helical computed tomography (CT). Both tests revealed free intraperitoneal fluid, but neither detected a splenic defect. The patient subsequently underwent splenectomy for a ruptured spleen. His serology for typical viral causes was negative. This article discusses spontaneous splenic rupture, the role of imaging in diagnosis, and the limitations of ED ultrasound and contrast enhanced helical CT.

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Spontaneous splenic rupture in infectious mononucleosis

Abstract: Spontaneous splenic rupture is a rare but life‐threatening complication of infectious mononucleosis. Abdominal pain and tachycardia are unusual in uncomplicated infectious mononucleosis and should alert a doctor to the possibility of spontaneous splenic rupture.

Cited by 15 publications

References 11 publications

Spontaneous Splenic Rupture in Infectious Mononucleosis

Spontaneous Splenic Rupture in Infectious Mononucleosis

Splenectomy in severe haemophilia

Unusual case of acute onset abdominal pain: uses and limitations of medical imaging

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