{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T08:12:22Z","timestamp":1788595942333,"version":"build-2803163510"},"reference-count":33,"publisher":"BMJ","issue":"9","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,8,15]]},"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:p>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.<\/jats:p>\n                  <jats:p>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.<\/jats:p>","DOI":"10.1136\/bcr-2025-269528","type":"journal-article","created":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T07:35:12Z","timestamp":1788593712000},"page":"e269528","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Multidisciplinary management of Epstein\u2013Barr virus-associated atraumatic splenic rupture incorporating splenic artery embolisation and intraoperative cell salvage"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-2874-4445","authenticated-orcid":false,"given":"Hanin","family":"Ramadan","sequence":"first","affiliation":[{"name":"Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haruna","family":"Takahashi","sequence":"additional","affiliation":[{"name":"Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anastasia","family":"Aslani","sequence":"additional","affiliation":[{"name":"Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,9,4]]},"reference":[{"key":"2026090500500485000_19.9.e269528.1","doi-asserted-by":"crossref","DOI":"10.1186\/s12875-019-0954-3","article-title":"Epstein-Barr virus and its association with disease - a review of relevance to general practice","volume":"20","author":"Fugl","year":"2019","journal-title":"BMC Fam Pract"},{"key":"2026090500500485000_19.9.e269528.2","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-020-09049-x","article-title":"Epidemiology of Epstein-Barr virus infection and infectious mononucleosis in the United Kingdom","volume":"20","author":"Kuri","year":"2020","journal-title":"BMC Public Health"},{"key":"2026090500500485000_19.9.e269528.3","doi-asserted-by":"publisher","DOI":"10.1146\/annurev.immunol.25.022106.141553"},{"key":"2026090500500485000_19.9.e269528.4","doi-asserted-by":"crossref","DOI":"10.57187\/smw.2023.40081","article-title":"Splenic rupture or infarction associated with Epstein-Barr virus infectious mononucleosis: a systematic literature review","volume":"153","author":"Toti","year":"2023","journal-title":"Swiss Med Wkly"},{"key":"2026090500500485000_19.9.e269528.5","doi-asserted-by":"crossref","first-page":"101680","DOI":"10.1016\/j.epsc.2020.101680","article-title":"Spontaneous splenic rupture secondary to Epstein-Barr Virus-induced infectious mononucleosis","volume":"63","author":"Lee","year":"2020","journal-title":"J Pediatr Surg Case Rep"},{"key":"2026090500500485000_19.9.e269528.6","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1177\/000313480807400516","article-title":"Progressive splenomegaly following splenic artery embolization","volume":"74","author":"Runyan","year":"2008","journal-title":"Am Surg"},{"key":"2026090500500485000_19.9.e269528.7","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1016\/j.jss.2024.05.012","article-title":"Clinical Outcomes of Splenic Artery Embolization Versus Splenectomy in the Management of Hemodynamically Stable High-Grade Blunt Splenic Injuries: A National Analysis","volume":"300","author":"Breeding","year":"2024","journal-title":"J Surg Res"},{"key":"2026090500500485000_19.9.e269528.8","first-page":"1023","article-title":"Splenic artery embolization in blunt splenic injury: a systematic review and meta-analysis","volume":"89","author":"Asensio","year":"2023","journal-title":"Am Surg"},{"key":"2026090500500485000_19.9.e269528.9","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2141.2011.08843.x"},{"key":"2026090500500485000_19.9.e269528.10","unstructured":"Public Health England . 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