Spontaneous Rupture of Spleen (SRS) in Infectious Mononucleosis (IM) - Embolization of Splenic Artery to Save the Spleen

Abstract

Purpose: Spontaneous rupture of spleen (SRS) is a rare but fatal complication of Infectious Mononucleosis (IM) with a reported incidence of 0.1 - 0.5%. Management usually consists of splenectomy in hemodynamically unstable patients and non-operative surveillance in stable patients. We report the successful use of splenic artery embolization as an alternative treatment in an unstable patient. Case: A previously healthy 18-year-old male admitted to the hospital with the sudden onset of left sided abdominal pain and pre-syncope after 1 week of fever and sore throat. On examination, he had BP of 86/46 and HR of 112 with severe left upper quadrant tenderness. Blood work showed Hemoglobin (Hb) of 12.3 which dropped to 6.4 in 6 hours of presentation and he was transfused with 2 units of packed RBCs. Abdominal CT scan revealed a grade III splenic laceration with large amount of blood in peritoneal cavity (Figure 1). Splenic artery arteriography along with embolization of the main splenic artery was performed (Figure 2). After the procedure his Hb stabilized, abdominal pain improved and fever resolved. Subsequently Epstein-barr virus serology was positive with a titer >160 u/ml. Repeat CT scan in 4 days after the procedure showed multiple regions of splenic infarction but the majority of the spleen was preserved. His Hb stabilized and was discharged on day 6 of his hospitalization.Figure 1Figure 2Discussion: Splenic artery embolization has not been studied well in cases of SRS secondary to IM. The majority of the literature is on splenectomy in unstable patients or non-operative watchfulness in stable patients. This methodology preserves spleen and prevents the dreadful complication of overwhelming post splenectomy infection, risks of laparotomy and the consequent morbidity and mortality in apslenic patients.