Spontaneous splenic rupture causing cardiac arrest in an adolescent with infectious mononucleosis successfully managed with damage control laparotomy and splenectomy: A case report

Introduction Infectious mononucleosis caused by Epstein-Barr Virus (EBV) commonly results in splenomegaly and primarily affects adolescents. Spontaneous splenic rupture in the setting of infectious mononucleosis is a rare and life-threatening condition which occurs in 0.1-0.5% of cases. Management of spontaneous splenic rupture varies significantly and remains without a universal standard of care. Case Presentation We report the case of a 17-year-old male with infectious mononucleosis who presented in cardiac arrest after a witnessed collapse without preceding trauma. After successful resuscitation he was found to have splenomegaly measuring up to 18x7x5cm and surrounding hemoperitoneum and what appeared to be a capsular rupture. He emergently underwent a damage control laparotomy with splenectomy, packing and application of hemostatic products. Due to hemodynamic instability from hemorrhagic shock, hypothermia and coagulopathy, a temporary abdominal closure device was applied, and he was subsequently transferred to the intensive care unit. Thromboelastography (TEG) was utilized to help guide balanced resuscitation and targeted correction of coagulopathy multiple times during his stay in the intensive care unit (ICU). The first repeat abdominal exploration occurred approximately 12 hours after initial laparotomy due to significant vasopressor needs with concern for ongoing intra-abdominal hemorrhage. He underwent the third and fourth repeat laparotomies on hospital days 2 and 5. By day 5 adequate hemostasis and resuscitation had been achieved, and his abdomen was successfully closed. His hospital course required two weeks of supportive care in the ICU where he required a temporary period of hemodialysis. By hospital day 22 he had recovered to the point where he was able to be discharged to an inpatient rehabilitation facility. On his one-month follow-up he was found to be recovering well and had successfully returned to work as a cashier. Conclusion Damage control laparotomy and splenectomy may lead to survival in selected cases of adolescents with EBV-associated spontaneous splenic rupture and pre-hospital cardiac arrest.