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10 February 2009

Spontaneous splenic rupture after laparotomy performed in patient with infectious mononucleosis

Kryspin Mitura, Alicja Mitura, Mikołaj Romańczuk

Am J Case Rep 2009; 10:12-14 :: ID: 869561

Abstract

Background: Fatalities secondary to infectious mononucleosis are extremely rare and most often are the result of splenic rupture. The incidence of this dramatic complication of Epstein-Barr virus infection is highest in second and third week of the illness. Although, the introduction of non operative treatment is now accepted as an alternative to splenectomy, still laparotomy remains the method of choice in hemodynamically unstable patients.
Case Report: A previously healthy 27-year-old female presented with acute onset of abdominal pain, nausea and vomiting. There was no history of abdominal trauma. For three weeks prior to admission to hospital, she complained of sore throat, malaise and fever. The clinical and laboratory examinations confirmed infectious mononucleosis and anemia. The ultrasonography showed enlarged ovary and large amount of free pelvic fluid. The patient underwent emergent surgery. At laparotomy, an actively bleeding ruptured cyst of the ovary was found to be the cause of the hemoperitoneum. Two hours later the patient’s condition suddenly worsened. Patient was clinically shocked with pallor, hypotension and tachycardia. The drain collected 700 mL of blood. Patient was subjected to another immediate laparotomy. The peritoneal cavity contained a large amount of clotted and fluid blood. The pulp of the enlarged spleen was completely disintegrated and a long tear was found on its anterior margin. A splenectomy was performed. She made a good recovery and was discharged from hospital after a 12-day hospital stay.
Conclusions: Patients with symptoms of hypovolemic shock and abdominal pain following infectious mononucleosis should be suspected of having splenic rupture. Operative management still remains the preferred treatment for spontaneous rupture of the spleen following infectious mononucleosis, especially in hemodynamically unstable patients.

Keywords: Infectious Mononucleosis, Splenectomy, splenic rupture

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923