Published online August 1, 2007
PEDIATRICS Vol. 120 No. 2 August 2007, pp. e432-e435 (doi:10.1542/peds.2006-3071)
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EXPERIENCE & REASON

Nonoperative Management of Spontaneous Splenic Rupture in Infectious Mononucleosis: A Case Report and Review of the Literature

Jacob T. Stephenson, MDa and Jeffrey J. DuBois, MD, FACS, FAAPb

a General Surgery, David Grant Medical Center, Travis Air Force Base, California
b Pediatric Surgery, Kaiser Permanente Health System, Sacramento, California

ABSTRACT

Spontaneous rupture of the spleen is a rare complication of infectious mononucleosis with no clear consensus on appropriate management. Although management of traumatic splenic rupture has largely moved to nonoperative treatment, splenectomy is still frequently used in dealing with rupture of the diseased spleen. Here we report the case of a 16-year-old boy with splenic rupture secondary to laboratory-confirmed infectious mononucleosis in the absence of trauma. Nonoperative management including ICU admission, serial computed tomography scans, and activity limitation was used successfully. Our experience, along with a review of the literature, leads us to conclude that splenic preservation can be a safe alternative to splenectomy in hemodynamically stable patients with spontaneous splenic rupture. This is of particular importance in the pediatric population, which is at higher risk for postsplenectomy sepsis.

Key Words: mononucleosis • splenic rupture • nonoperative • spleen

Abbreviations: IM, infectious mononucleosis • CT, computed tomography

Accepted Jan 26, 2007.


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