{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T19:28:49Z","timestamp":1786649329453,"version":"build-2736575974"},"reference-count":7,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:p>Atraumatic splenic rupture (ASR) is a rare but life-threatening event that usually occurs in diseased spleens and can complicate systemic infections. Among infectious causes, Epstein\u2013Barr virus (EBV) is the most frequently implicated, with rupture recognized as one of the most serious complications of infectious mononucleosis. Although the incidence is estimated at only 0.1%\u20130.5%, mortality can reach 5%\u201310% if diagnosis and treatment are delayed. Patients often present with abdominal pain, hypotension, or shock, but symptoms may be subtle and mimic other acute conditions. We report three cases of ASR in older adults. Case 1 involved a 79-year-old man with sudden abdominal pain and hypotension; he deteriorated under conservative management and required emergency splenectomy. EBV serology was positive. Case 2 was a 67-year-old woman admitted with collapse and sepsis-like features; computed tomography (CT) confirmed rupture, and she underwent splenectomy followed by a complicated postoperative course. EBV polymerase chain reaction was positive. Case 3, a 73-year-old woman with recent pneumonia, presented with dizziness and abdominal\/back pain; CT confirmed rupture, and she underwent splenectomy. EBV testing was not performed. Histopathology in all three showed capsular rupture with hemorrhage but no lymphoma or malignancy. Each patient received postsplenectomy vaccination and antibiotic prophylaxis. These cases highlight the variable presentation of ASR, including EBV-associated forms, and emphasise the pivotal role of CT in diagnosis and the frequent need for splenectomy in unstable patients. Vigilance, rapid imaging, and adherence to postsplenectomy prophylaxis are critical for improving survival in this uncommon but serious condition.<\/jats:p>","DOI":"10.4103\/jets.jets_187_25","type":"journal-article","created":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T03:00:53Z","timestamp":1775790053000},"page":"103-106","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Spontaneous Splenic Rupture without Trauma: Clinical Insight from a Three-case Series"],"prefix":"10.4103","volume":"19","author":[{"given":"Riyaz","family":"Sogiawalla","sequence":"first","affiliation":[{"name":"Bedfordshire Hospitals NHS Foundation Trust, Kempston, Bedford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey Pradeep","family":"Raj","sequence":"additional","affiliation":[{"name":"Division of Clinical Pharmacology, Department of Pharmacology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Firoze","family":"Sogiawalla","sequence":"additional","affiliation":[{"name":"Bedfordshire Hospitals NHS Foundation Trust, Kempston, Bedford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,4,9]]},"reference":[{"key":"R1-20260624","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1016\/j.ijscr.2011.08.012","article-title":"Spontaneous splenic rupture resulted from infectious mononucleosis","volume":"3","author":"Won","year":"2012","journal-title":"Int J Surg Case Rep"},{"key":"R2-20260624","doi-asserted-by":"crossref","first-page":"31","DOI":"10.5334\/jbsr.3536","article-title":"Epstein-Barr virus-associated atraumatic splenic rupture","volume":"108","author":"De Vis","year":"2024","journal-title":"J Belg Soc Radiol"},{"key":"R3-20260624","doi-asserted-by":"crossref","first-page":"1114","DOI":"10.1002\/bjs.6737","article-title":"Systematic review of atraumatic splenic rupture","volume":"96","author":"Renzulli","year":"2009","journal-title":"Br J Surg"},{"key":"R4-20260624","doi-asserted-by":"crossref","first-page":"e230259","DOI":"10.1136\/bcr-2019-230259","article-title":"Spontaneous splenic rupture in a patient with infectious mononucleosis","volume":"12","author":"Baker","year":"2019","journal-title":"BMJ Case Rep"},{"key":"R5-20260624","doi-asserted-by":"crossref","first-page":"111609","DOI":"10.1016\/j.ijscr.2025.111609","article-title":"A spontaneous splenic rupture secondary to Epstein Barr virus infection: A case report","volume":"133","author":"Munzi","year":"2025","journal-title":"Int J Surg Case Rep"},{"key":"R6-20260624","doi-asserted-by":"crossref","first-page":"1536","DOI":"10.3390\/diagnostics14141536","article-title":"Spontaneous splenic rupture secondary to infectious mononucleosis","volume":"14","author":"Kountouri","year":"2024","journal-title":"Diagnostics (Basel)"},{"key":"R7-20260624","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1007\/s13244-016-0500-y","article-title":"Atraumatic splenic rupture, an underrated cause of acute abdomen","volume":"7","author":"Tonolini","year":"2016","journal-title":"Insights Imaging"}],"container-title":["Journal of Emergencies, Trauma, and Shock"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/jets.jets_187_25","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T18:52:33Z","timestamp":1786647153000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/jets.jets_187_25"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4]]},"references-count":7,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.4103\/jets.jets_187_25","relation":{},"ISSN":["0974-2700","0974-519X"],"issn-type":[{"value":"0974-2700","type":"print"},{"value":"0974-519X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4]]},"assertion":[{"value":"2025-10-19","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-01-16","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}