Four cases of spontaneous
splenic rupture after
infectious mononucleosis (IM) have been treated at this institution since 1978. The condition is rare, occurring in 0.1-0.5 per cent of patients with proven
infectious mononucleosis.
Splenectomy is considered the treatment of choice for these patients. However, because recent trends in the management of traumatic
splenic rupture are moving towards nonoperative treatment with selected patients, a similar approach has been considered for the patient with spontaneous
splenic rupture following IM. The major reason for avoiding
splenectomy is the increased incidence of
sepsis in splenectomized patients. Yet,
splenic rupture is accompanied by
hemorrhage and the risks associated with
blood transfusion for ongoing
hemorrhage are of similar magnitude as those of
sepsis following
splenectomy. In addition, the grossly abnormal spleens seen at operation tend to include large, contained
hematomas that may also be prone to
rupture. Therefore, operative management still appears to be the preferred treatment for spontaneous
splenic rupture following IM.
Splenectomy is curative, safe, and obviates the need for transfusion, extended hospitalization, and activity restriction.