Wilson George G, Rennie Kelly
Charleston Area Medical Center, Department of General Surgery, 3100 MacCorkle Avenue, Suite 700 Charleston, WV 25304, United States.
Charleston Area Medical Center, Department of Trauma and Critical Care, 501 Morris St, Charleston, WV 2530, United States.
J Surg Case Rep. 2025 Jun 26;2025(6):rjaf420. doi: 10.1093/jscr/rjaf420. eCollection 2025 Jun.
Spontaneous splenic rupture is a rare but life-threatening complication of infectious mononucleosis, occurring in 0.1%-0.5% of cases. We present a 16-year-old female with infectious mononucleosis who developed a spontaneous splenic rupture. Initially managed nonoperatively with distal splenic artery embolization for a grade 3 splenic injury, she later re-presented with worsening abdominal pain. A grade 4 splenic injury with persistent splenic artery flow required an open splenectomy. She was discharged on postoperative day five after drain removal and vaccinations. This case underscores the complexity of managing spontaneous splenic rupture. Although embolization is often effective, failure rates vary, particularly in atraumatic splenic injuries. Early post-embolization imaging and standardized coiling protocols may improve outcomes. Clinicians should remain vigilant for splenic rupture in adolescents with infectious mononucleosis presenting with acute abdominal pain. Further research is needed to assess embolization efficacy in atraumatic splenic injuries.
自发性脾破裂是传染性单核细胞增多症一种罕见但危及生命的并发症，发生率为0.1%-0.5%。我们报告一名16岁患传染性单核细胞增多症的女性，她发生了自发性脾破裂。最初因3级脾损伤接受非手术治疗，即远端脾动脉栓塞术，后来她因腹痛加重再次就诊。4级脾损伤且脾动脉持续有血流，需要行开放性脾切除术。术后第5天拔除引流管并接种疫苗后她出院了。该病例强调了处理自发性脾破裂的复杂性。尽管栓塞术通常有效，但失败率各不相同，尤其是在非创伤性脾损伤中。栓塞术后早期成像和标准化的弹簧圈栓塞方案可能会改善治疗效果。临床医生应对出现急性腹痛的传染性单核细胞增多症青少年的脾破裂保持警惕。需要进一步研究以评估栓塞术在非创伤性脾损伤中的疗效。
