Sagüi-De FL, Álvarez-Barragán AF, Palacios-Saucedo GJ, García-Salas JJ, Almaraz-Celis GD

Language: Spanish
References: 18
Page: 89-94
PDF size: 233.86 Kb.

ABSTRACT

Introduction: Hand-assisted laparoscopic splenectomy (HALS) is considered an elective treatment for splenomegaly of more than 20 cm. The incidence of atraumatic rupture due to infectious mononucleosis ranges from 0.1-0.5% and has a mortality of 9%. We present the case of a patient with atraumatic splenic rupture secondary to infectious mononucleosis (IM) who underwent ELMA. Case report: 50-year-old male, with severe obesity and thrombocytopenic purpura, who came to the emergency room with abdominal pain radiating to the left shoulder, with positive serology for dengue and Epstein-Barr virus (EBV). A computerized axial tomography showed a 24 cm spleen, free fluid in the paracolic grooves and both iliac fossae. He was hospitalized and 24 hours after admission he presented with severe abdominal pain and data of grade IV hypovolemic shock. Surgical technique: Urgent diagnostic laparoscopy was decided with findings of splenic rupture and hemoperitoneum of three liters. Hand-assisted laparoscopic splenectomy was performed and shock controlled. Conclusions: Splenic rupture due to mononucleosis, although rare, should be considered as a probable diagnosis in cases of splenomegaly and hypovolemic shock. ELMA can be considered as a diagnostic and therapeutic option for these cases, without the need to convert to open surgery.

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