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Spontaneous rupture of the spleen is a rare, but serious complication of infectious mononucleosis with no clear consensus on appropriate management. Although management of traumatic splenic rupture has largely moved to non-operative treatment, splenectomy is still frequently used in dealing with rupture of the diseased spleen. Here we report the case of a 27-year-old boy with splenic rupture secondary to laboratory-confirmed infectious mononucleosis in the absence of trauma. Our management included an endovascular treatment (embolization of the splenic artery), serial ultrasound scans, activity limitation, and a computed tomography low-dose scan before discharge. Our experience, along with a review of the literature, has led us to conclude that splenic preservation can be a safe alternative to splenectomy in hemodynamically stable patients with spontaneous splenic rupture. This is of particular importance in the young population, which is at higher risk for postsplenectomy sepsis.

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