Spontaneous rupture of the spleen in patients with infectious mononucleosis

The author describes two cases of spontaneous splenic rupture occurring with infectious mononucleosis in young, previously healthy patients. The reports illustrate the variable clinical presentation--from sudden, fatal hemorrhage to bleeding that stops spontaneously. Although conservative nonoperative treatment may be successful in carefully selected cases, laparotomy with splenectomy appears to be the safest therapeutic approach. When a nonoperative approach is selected, the patient should be observed in a critical-care facility with immediate access to an operating room. Normal activity should not be resumed until the spleen has returned to its normal size as demonstrated by computed tomography or ultrasonography.