Spontaneous Spleen Rupture Due to Infectious Mononucleosis

Öz

Spontaneous spleen rupture (SSR) is a fatal and rare pathology causing acute abdomen. SSR secondary to infectious mononucleosis (IM) is quite rare (0.06-0.5%), and it is the most common cause of IM associated death. A 43 years old male patient, who had no previous severe disease history, chronic drug use, or previous operation applied to our emergency outpatient clinic of general surgery. The patient had complaints of severe abdominal pain, nausea, vomiting, and diarrhea. In abdominal computerized tomography, diffuse free fluid with respectively increased in density (hemorrhage?) was observed. Emergency operation was decided, because patient developed acute peritonitis signs. During exploration in the operation, it was observed that spleen was ruptured at multiple sites, and bleeding was ongoing, and splenectomy was performed. Serology was consistent with the previous EBV infection. It was mentioned in the pathology report that there was no neoplastic infiltration, and infectious causes should be investigated. No problem has been encountered during approximately two years’ follow-up. SSR secondary to EMN is a rare, fatal, and very severe pathology. Diagnosis is delayed, or it is not even diagnosed because there is no trauma. Correct diagnosis on time, and decision of emergency surgical intervention can be life-saving.

Anahtar Kelimeler

• Spontaneous Spleen Rupture
• Infectious Mononucleosis
• Surgery

Kaynakça

1. Referans1. Acar YA, Dedouglu E, Cevik E, Cinar O, Arslan D, Kesim E, et al. Spontaneous rupture of spleen as a rare cause of abdominal pain. Eur J Surg Sci. 2010;1:27–29.
2. Referans2. Orloff MJ, Peskin GW. Spontaneous rupture of the normal spleen; a surgical enigma. Int Abstr Surg. 1958;106:1–11.
3. Referans3. Won AC, Ethell A. Spontaneous splenic rupture resulted from infectious mononucleosis. Int J Surg Case Rep. 2012;3(3):97-99.
4. Referans4. Renzulli P, Hostettler A, Schoepfer AM, Gloor B, Candinas D. Systematic review of atraumatic splenic rupture. Br J Surg. 2009;96:1114–1121.
5. Referans5. Crate ID, Payne MJ. Is the diagnosis of spontaneous rupture of a normal spleen valid? J R Army Med Corps. 1991;137:50–51.
6. Referans6. Hosey RG, Kriss V, Uhl TL, DiFiori J, Hecht S, Wen DY. Ultrasonographic evaluation of splenic enlargement in athletes with acute infectious mononucleosis. Br J Sports Med. 2008; 42(12):974-977.
7. Referans7. Görg C, Cölle J, Görg K, Prinz H, Zugmaier G. Spontaneous rupture of the spleen: Ultrasound patterns, diagnosis and follow-up. Br J Radiol. 2003;76:704–711.
8. Referans8. O'Connor TE, Skinner LJ, Kiely P, Fenton JE. Return to contact sports following infectious mononucleosis: the role of serial ultrasonography. Ear Nose Throat J. 2011;90(8):E21-4.