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Splenic rupture and infectious mononucleosis
1Department of Surgery, Conemaugh Valley Memorial Hospital, Johnstown, Pennsylvania.
Abstract:
Infectious mononucleosis is an acute viral illness associated with a high incidence of splenomegaly, although the incidence of splenic rupture is low. When rupture occurs, the mortality has been significant, presumably, because a history of trauma is not present. The spleen may be vulnerable to injury due to the histopathologic changes that occur as a result of this illness. Essentially all patients with spontaneous rupture related to infectious mononucleosis have epigastric or upper abdominal pain. The diagnosis of splenic rupture may be confirmed in a variety of ways. In those patients who are hemodynamically stable, CT scan, ultrasound, or radionuclide scan may aid in establishing the diagnosis. Selective splenic angiography is very accurate but has been largely abandoned because of the invasive nature of the study. Peritoneal lavage is efficacious in establishing the diagnosis in hemodynamically unstable patients. The treatment of choice, at this time, is splenectomy. Current interest in splenic salvage has resulted in reports of nonoperative therapy in stable patients and splenorrhaphy in one instance. Due to the extent of the histologic changes in the spleen, caution is urged in electing the conservative approach to this clinical situation.
Insights
Infectious mononucleosis can cause spleen rupture, a rare but serious complication. Prompt diagnosis and treatment, often splenectomy, are crucial due to potential high mortality without trauma history.
Area of Science:
- Medicine
- Infectious Diseases
- Gastroenterology
Background:
- Infectious mononucleosis frequently causes splenomegaly.
- Splenic rupture is a rare but life-threatening complication of infectious mononucleosis.
Observation:
- Patients with spontaneous splenic rupture often present with epigastric or upper abdominal pain.
- Diagnostic methods include CT scan, ultrasound, radionuclide scan, and peritoneal lavage.
- Selective splenic angiography is accurate but rarely used due to invasiveness.
Findings:
- Histopathologic changes in the spleen increase vulnerability to injury.
- Mortality is significant in cases of splenic rupture, often without a history of trauma.
Implications:
- Splenectomy remains the primary treatment for splenic rupture.
- Conservative management (nonoperative therapy or splenorrhaphy) is being explored for stable patients.
- Caution is advised with conservative approaches due to the spleen's altered histology.