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Overview :
A patient with malaria and splenomegaly may have rupture of the
spleen. This can be managed conservatively in many cases provided certain
criteria are met. The management is similar to that for traumatic rupture of the
spleen.
Criteria for conservative management:
(1) hemodynamically stable (normotensive with stable pulse)
(2) no signs of clinical deterioration (clinically stable)
(3) stable hemoglobin with <= 2 units of blood transfused
(4) compliant with bed rest
where:
• The time
period over which the blood is transfused is not stated.
• According to
Hamel et al, spontaneous rupture of the spleen is more of a problem for
Plasmodium vivax infections.
Features of conservative management:
(1) scrupulous bed rest for several weeks, until completely
resolved
(2) careful monitoring
(3) periodic CT scans to monitor resolution of injury or to
detect expansion
(4) access to emergency services if signfiicant rupture
occurs
Delayed rupture may occur with medical management, especially if
the conservative management is stopped too soon.
If surgery is required, then surgical repair or partial
resection should be tried, with complete splenectomy performed only when all
else fails.
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