Citation

Ioannides D, Davies M, Kluzek S. BMJ Case Rep. 2017; 2017(ePub): ePub.

Affiliation

The Botnar Research Centre (NDORMS), Oxford University Hospitals, Oxford, UK.

Copyright

(Copyright © 2017, BMJ Publishing Group)

DOI

10.1136/bcr-2017-222160

PMID

28942415

Abstract

A 19-year-old man was sent to the emergency department following a pitch-side assessment for suspected concussion, unexplained upper abdominal tenderness and vomiting, following a high-impact tackle during a rugby match. A Focussed Assessment with Sonography for Trauma (FAST) scan performed in the emergency department suggested intra-abdominal free fluid, and subsequent head and abdominal CT imaging showed no intracranial lesion but confirmed a significant haemoperitoneum due to large splenic tear and bleeding. An emergency splenectomy was performed, which confirmed the rupture of an enlarged spleen with blood loss of almost 2 L into the peritoneal cavity. The patient made a full recovery following surgery. A subsequent histological examination revealed granulomatous inflammation characteristic of infectious mononucleosis. This unique case illustrates that physically fit patients with early hypovolaemic shock can present with symptoms mimicking concussion.

© BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Language: en

Keywords

ear, nose and throat/otolaryngology; infectious diseases; prehospital; sports and exercise medicine; trauma