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[Splenic rupture in infectious disease: splenectomy or conservative treatment? Report of three cases]
1Service des maladies infectieuses et tropicales, hôpital d'instruction des armées Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France. RAPPCHRISTOPHE@aol.com
Introduction:
Spontaneous splenic ruptures are rare but life-threatening complications of infectious diseases. Splenectomy is still the treatment of choice but numerous recent reports have documented favorable outcome with conservative treatment.
Exegesis:
We report three cases of splenic rupture occurring respectively with infectious mononucleosis, P. vivax infection and dengue fever. Diagnosis, treatment and indications are reviewed, an approach to management is suggested. The study included three military men respectively aged 23, 24 and 35 years, admitted for acute abdominal pain in the left upper quadrant. The abdominal computed tomography confirmed partial rupture (splenic hematoma) in the first two cases, and an hemoperitoneum in the dengue case. Splenic ruptures can reveal or complicate an evolving infection. Rupture can happen spontaneously or as a result of trauma, which may be minor and unnoticed. The typical presentation is acute, but progressive forms are described. The diagnosis is made by ultrasound and CT scan. Splenectomy dogma tends to be supplanted by conservative treatment. Non-operative management can be successful if appropriate criteria and a long period of follow-up are applied in carefully selected cases. When an operative approach is selected, conservative surgical treatment is attractive. Splenectomy should be reserved for patients with uncontrollable rupture or with recurrent splenic bleeding.
Conclusion:
Spontaneous splenic rupture are uncommon in infectious diseases. A multidisciplinary management is necessary. A conservative treatment should be considered in selected, closely monitored patients.
Insights
Spontaneous splenic rupture, a rare complication of infections like mononucleosis and dengue fever, can be managed conservatively. Careful patient selection and monitoring are key for successful non-operative treatment of splenic rupture.
Area of Science:
- Infectious Diseases
- Surgical Pathology
- Abdominal Imaging
Background:
- Spontaneous splenic rupture is a rare but serious complication of infectious diseases.
- While splenectomy has been the traditional treatment, conservative management is increasingly reported as a viable option.
Observation:
- Three cases of splenic rupture associated with infectious mononucleosis, Plasmodium vivax infection, and dengue fever are presented.
- Diagnosis was confirmed using computed tomography (CT) scans, revealing splenic hematoma or hemoperitoneum.
- Patients presented with acute left upper quadrant abdominal pain.
Findings:
- Spontaneous splenic rupture can be a presenting sign or complication of infections.
- Diagnosis relies on imaging modalities such as ultrasound and CT scans.
- Conservative, non-operative management is effective in carefully selected cases with appropriate follow-up.
Implications:
- A multidisciplinary approach is essential for managing spontaneous splenic rupture in infectious diseases.
- Conservative treatment should be strongly considered for selected patients under close observation.
- Splenectomy should be reserved for cases of uncontrollable bleeding or recurrent splenic rupture.