Ypma Dineke, Coolsma Constant, Eker Hasan, Vrooland Marc, Vink Ted W F, Lameijer Heleen
Medisch Centrum Leeuwarden, afd. Spoedeisende Hulp, Leeuwarden.
Medisch Centrum Leeuwarden, afd. Chirurgie, Leeuwarden.
Ned Tijdschr Geneeskd. 2019 Jul 29;163:D2986.
Spontaneous rupture of the spleen occurs in 0.1-0.2% of patients with infectious mononucleosis and is associated with a high mortality (9-13%). Rupture is not normally preceded by a trauma.
A previously healthy 17- year-old boy presented at the Emergency Department with acute onset of pain in his left upper abdomen and left shoulder. Initially he showed no signs of shock, but he did have signs of an acute abdomen. In addition, spots of pus were seen on both pharyngeal arches. Urgent ultrasound showed free fluid in his abdomen, and CT scan revealed active bleeding from the spleen. The patient underwent embolisation of the splenic artery. Serological investigations were positive for a recent infection with the Epstein-Barr virus.
In young patients with signs of acute abdomen and pharyngitis, in the absence of prior trauma, spontaneous rupture of the spleen should be considered. The severity of a rupture of the spleen may initially be underestimated as haemodynamic instability and signs of shock occur only at a late stage.
脾脏自发性破裂发生于0.1% - 0.2%的传染性单核细胞增多症患者中，且与高死亡率（9% - 13%）相关。破裂通常并非由外伤所致。
一名既往健康的17岁男孩因左上腹和左肩急性疼痛就诊于急诊科。起初他没有休克迹象，但有急腹症体征。此外，双侧咽弓可见脓斑。紧急超声检查显示其腹腔内有游离液体，CT扫描显示脾脏有活动性出血。该患者接受了脾动脉栓塞术。血清学检查显示近期感染爱泼斯坦 - 巴尔病毒呈阳性。
对于有急腹症体征且患有咽炎的年轻患者，在无既往外伤史的情况下，应考虑脾脏自发性破裂。脾脏破裂的严重程度最初可能被低估，因为血流动力学不稳定和休克体征仅在晚期出现。
