Multidisciplinary management of Epstein-Barr virus-associated atraumatic splenic rupture incorporating splenic artery embolisation and intraoperative cell salvage.

A young woman presented with abdominal pain and jaundice secondary to Epstein-Barr virus-induced hepatitis and splenomegaly. She collapsed and CT imaging showed a large haemoperitoneum secondary to atraumatic splenic rupture. Splenic artery embolisation was attempted without success, and subsequently she underwent an open splenectomy. A collaborative multidisciplinary approach and adequate hospital set-up allowed for an initial attempt at non-operative intervention with the aim of splenic preservation, with rapid conversion to open surgery when necessary. Total blood loss of 7.5 litres was replaced with allogeneic and autologous blood products. Cell salvage was a key adjunct for supporting resuscitation and blood conservation intraoperatively.This case emphasises the need for careful planning of backup definitive intervention when attempting non-operative management in such cases, with discussion based on current evidence. We also highlight relevant factors when considering the use of intraoperative cell salvage as part of atraumatic splenic rupture management.