Case report of a splenectomy secondary to infectious mononucleosis in a 16-year-old female.

Spontaneous splenic rupture is a rare but life-threatening complication of infectious mononucleosis, occurring in 0.1%-0.5% of cases. We present a 16-year-old female with infectious mononucleosis who developed a spontaneous splenic rupture. Initially managed nonoperatively with distal splenic artery embolization for a grade 3 splenic injury, she later re-presented with worsening abdominal pain. A grade 4 splenic injury with persistent splenic artery flow required an open splenectomy. She was discharged on postoperative day five after drain removal and vaccinations. This case underscores the complexity of managing spontaneous splenic rupture. Although embolization is often effective, failure rates vary, particularly in atraumatic splenic injuries. Early post-embolization imaging and standardized coiling protocols may improve outcomes. Clinicians should remain vigilant for splenic rupture in adolescents with infectious mononucleosis presenting with acute abdominal pain. Further research is needed to assess embolization efficacy in atraumatic splenic injuries.