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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.

Original publication

DOI

10.1136/bcr-2017-222160

Type

Journal article

Journal

BMJ Case Rep

Publication Date

23/09/2017

Volume

2017

Keywords

ear, nose and throat/otolaryngology, infectious diseases, prehospital, sports and exercise medicine, trauma, Athletic Injuries, Confusion, Diagnosis, Differential, Emergency Treatment, Football, Hemoperitoneum, Humans, Infectious Mononucleosis, Male, Spleen, Splenectomy, Splenic Rupture, Young Adult