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. 1978 Jan;54(627):51–55. doi: 10.1136/pgmj.54.627.51

Rupture of the spleen in a patient with a perforated duodenal ulcer and infectious mononucleosis

Robin Gray
PMCID: PMC2425048  PMID: 625460

Abstract

A 72-year-old patient presented as a sealed perforated duodenal ulcer. This was later confirmed at operation when in addition a haemoperitoneum due to a lacerated friable spleen was discovered. The patient denied antecedent injury. The peripheral blood film was normal but a subsequent differential slide test for infectious mononucleosis was positive. Histology of the spleen showed hyperplasia of the red pulp in addition to capsular and trabecular infiltration with lymphocytes and atypical mononuclear cells confirming the diagnosis. Infectious mononucleosis in the elderly is rare and a complicating rupture of the spleen at this stage has not been reported previously. The diagnosis may depend on the histology alone because the peripheral blood film and serology can be negative. The possible role of the perforated duodenal ulcer is discussed.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Carcinoma and Cushing's syndrome. Br Med J. 1961 Aug 19;2(5250):505–506. [PMC free article] [PubMed] [Google Scholar]
  2. Danforth D. N., Jr, Thorbjarnarson B. Incidental splenectomy: a review of the literature and the New York Hospital experience. Ann Surg. 1976 Feb;183(2):124–129. doi: 10.1097/00000658-197602000-00007. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Devlin H. B., Evans D. S., Birkhead J. S. The incidence and morbidity of accidental injury to the spleen occurring during abdominal surgery. Br J Surg. 1969 Jun;56(6):446–448. doi: 10.1002/bjs.1800560612. [DOI] [PubMed] [Google Scholar]
  4. EMBREY M. P., PAINTER N. S. Haemoperitoneum due to spontaneous rupture of the spleen during pregnancy. Br J Surg. 1962 Mar;49:575–576. doi: 10.1002/bjs.18004921717. [DOI] [PubMed] [Google Scholar]
  5. Foley W. J., Thompson N. W., Herlocher J. E., Campbell D. A. Occult rupture of the spleen. Surg Gynecol Obstet. 1969 Jun;128(6):1215–1220. [PubMed] [Google Scholar]
  6. GARDNER R. J., PRESTON F. W. Rupture of the spleen associated with pancreatitis. JAMA. 1961 Sep 16;177:784–785. doi: 10.1001/jama.1961.73040370016014a. [DOI] [PubMed] [Google Scholar]
  7. Grech A. Spontaneous rupture of spleen. Br Med J. 1971 Jan 9;1(5740):111–111. doi: 10.1136/bmj.1.5740.111-b. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. HOAGLAND R. J. RESURGENT HETEROPHIL-ANTIBODY REACTION AFTER MONONUCLEOSIS. N Engl J Med. 1963 Dec 12;269:1307–1308. doi: 10.1056/NEJM196312122692409. [DOI] [PubMed] [Google Scholar]
  9. Horwitz C. A., Polesky H., Stillman T., Ward P. C., Henle G., Henle W. Persistent haemagglutination for infectious mononucleosis in rheumatoid arthritis. Br Med J. 1973 Mar 10;1(5853):591–592. doi: 10.1136/bmj.1.5853.591. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Hyun B. H., Varga C. F., Rubin R. J. Spontaneous and pathologic rupture of the spleen. Arch Surg. 1972 May;104(5):652–657. doi: 10.1001/archsurg.1972.04180050028007. [DOI] [PubMed] [Google Scholar]
  11. ORLOFF M. J., PESKIN G. W. Spontaneous rupture of the normal spleen; a surgical enigma. Int Abstr Surg. 1958 Jan;106(1):1–11. [PubMed] [Google Scholar]
  12. Phillips G. M. False-positive monospot test result in rubella. JAMA. 1972 Oct 30;222(5):585–585. doi: 10.1001/jama.1972.03210050057025. [DOI] [PubMed] [Google Scholar]
  13. Rawsthorne G. B., Cole T. P., Kyle J. Spontaneous rupture of the spleen in infectious mononucleosis. Br J Surg. 1970 May;57(5):396–398. doi: 10.1002/bjs.1800570517. [DOI] [PubMed] [Google Scholar]
  14. Reisman D. D., Logan D. J. Rupture of the spleen secondary to renal sepsis. J Urol. 1967 Oct;98(4):426–430. doi: 10.1016/S0022-5347(17)62903-3. [DOI] [PubMed] [Google Scholar]
  15. SHAPIRO C. M., HORWITZ H. Infectious mononucleosis in the aged. Ann Intern Med. 1959 Nov;51:1092–1097. doi: 10.7326/0003-4819-51-5-1092. [DOI] [PubMed] [Google Scholar]
  16. Sadoff L., Goldsmith O. False-positive infectious mononucleosis spot test in pancreatic carcinoma. JAMA. 1971 Nov 22;218(8):1297–1298. [PubMed] [Google Scholar]
  17. Sakulsky S. B., Wallace R. B., Silverstein M. N., Dockerty M. B. Ruptured spleen in infectious mononucleosis. Arch Surg. 1967 Mar;94(3):349–352. doi: 10.1001/archsurg.1967.01330090043010. [DOI] [PubMed] [Google Scholar]
  18. Seltzer M. H., Quarantillo E. P., Jr Spontaneous splenic rupture in an anticoagulated patient: a case report. J Med Soc N J. 1973 May;70(5):397–398. [PubMed] [Google Scholar]
  19. Soyer M. T., Merck D. E., Aldrete J. S. Spontaneous rupture of the spleen. An unusual complication of anticoagulant therapy. Arch Surg. 1976 May;111(5):610–610. doi: 10.1001/archsurg.1976.01360230110025. [DOI] [PubMed] [Google Scholar]
  20. Surgical Memoranda. Br Med J. 1874 Sep 26;2(717):403–404. [PMC free article] [PubMed] [Google Scholar]
  21. Wall R. L., Macpherson C. R. A clinicopathological conference from the Ohio State University Hospital, Columbus, Ohio. Ohio State Med J. 1965 Nov;61(11):995–998. [PubMed] [Google Scholar]

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