Lokuhetty Naradha, Philip Moira Tereapii, Paynter Jessica Anne, Owen Andrew Robert
Department of General Surgery, Bendigo Health, Bendigo, Australia.
Department of Radiology, Austin Health, Heidelberg, Australia.
Radiol Case Rep. 2024 Feb 28;19(5):1970-1974. doi: 10.1016/j.radcr.2024.02.016. eCollection 2024 May.
Splenic rupture in haemodynamically unstable patients has traditionally been managed with splenectomy. This case report discusses the successful management of atraumatic splenic rupture, a rare but life-threatening complication of Epstein-Barr virus (EBV) infection, in a hemodynamically unstable patient. The patient, diagnosed with infectious mononucleosis (IM) secondary to EBV, presented with severe abdominal pain and a syncopal episode. Imaging revealed an American Association for the Surgery of Trauma (AAST) grade III splenic injury, which was subsequently upgraded to a grade IV injury on repeat imaging. The patient's condition deteriorated even with initial resuscitation, leading to splenic angioembolization. The procedure was successful and the patient was discharged after 5 days. This case highlights the efficacy of splenic artery embolization (SAE) in haemodynamically unstable patients with atraumatic splenic rupture, particularly in centers with interventional radiology resources, offering an alternative to splenectomy and its associated complications.
传统上，血流动力学不稳定的患者发生脾破裂时会进行脾切除术。本病例报告讨论了一名血流动力学不稳定的患者，成功处理了非创伤性脾破裂，这是一种罕见但危及生命的爱泼斯坦-巴尔病毒（EBV）感染并发症。该患者被诊断为继发于EBV的传染性单核细胞增多症（IM），出现严重腹痛和一次晕厥发作。影像学检查显示为美国创伤外科学会（AAST）III级脾损伤，再次影像学检查后随后升级为IV级损伤。即使经过初始复苏，患者的病情仍恶化，导致进行了脾血管栓塞术。该手术成功，患者在5天后出院。本病例突出了脾动脉栓塞术（SAE）在血流动力学不稳定的非创伤性脾破裂患者中的疗效，特别是在具备介入放射学资源的中心，为脾切除术及其相关并发症提供了一种替代方法。
