[Splenic rupture in infectious disease: splenectomy or conservative treatment? Report of three cases].
BACKGROUND
Spontaneous splenic ruptures are rare but life-threatening complications of infectious diseases. Splenectomy is still the treatment of choice but numerous recent reports have documented favorable outcome with conservative treatment.


METHODS
We report three cases of splenic rupture occurring respectively with infectious mononucleosis, P. vivax infection and dengue fever. Diagnosis, treatment and indications are reviewed, an approach to management is suggested. The study included three military men respectively aged 23, 24 and 35 years, admitted for acute abdominal pain in the left upper quadrant. The abdominal computed tomography confirmed partial rupture (splenic hematoma) in the first two cases, and an hemoperitoneum in the dengue case. Splenic ruptures can reveal or complicate an evolving infection. Rupture can happen spontaneously or as a result of trauma, which may be minor and unnoticed. The typical presentation is acute, but progressive forms are described. The diagnosis is made by ultrasound and CT scan. Splenectomy dogma tends to be supplanted by conservative treatment. Non-operative management can be successful if appropriate criteria and a long period of follow-up are applied in carefully selected cases. When an operative approach is selected, conservative surgical treatment is attractive. Splenectomy should be reserved for patients with uncontrollable rupture or with recurrent splenic bleeding.


CONCLUSIONS
Spontaneous splenic rupture are uncommon in infectious diseases. A multidisciplinary management is necessary. A conservative treatment should be considered in selected, closely monitored patients.
Rapp
C
C
Service des maladies infectieuses et tropicales, hôpital d'instruction des armées Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France. RAPPCHRISTOPHE@aol.com
Debord
T
T
Imbert
P
P
Lambotte
O
O
Roué
R
R
D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D003715:Dengue / Q000150:complications; D003937:Diagnosis, Differential; D006801:Humans; D007244:Infectious Mononucleosis / Q000150:complications; D008288:Malaria / Q000150:complications; D008297:Male; D013156:Splenectomy; D013161:Splenic Rupture / Q000209:etiology* / Q000628:therapy*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome