Fulminant Epstein-Barr virus - infectious mononucleosis in an adult with liver failure, splenic rupture, and spontaneous esophageal bleeding with ensuing esophageal necrosis: a case report.

INTRODUCTION: Infectious mononucleosis is a clinical syndrome most commonly associated with primary Epstein-Barr virus infection. The majority of patients with infectious mononucleosis recovers without apparent sequelae. However, infectious mononucleosis may be associated with several acute complications. In this report we present a rare case of esophageal rupture that has never been described in the literature before. CASE PRESENTATION: We present the case of an 18-year-old Caucasian man affected by severe infectious mononucleosis complicated by fulminant hepatic failure, splenic rupture and esophageal necrosis. CONCLUSIONS: Although primary Epstein-Barr virus infection is rarely fatal, fulminant infection may occur - in this case leading to hepatic failure, splenic rupture and esophageal necrosis, subsequently making several surgical interventions necessary. We show here that infectious mononucleosis is not only a strictly medical condition, but can also lead to severe surgical complications.

Internal transomental herniation with a trapped small bowel mimicking acute appendicitis.

INTRODUCTION: Internal herniation with subsequent bowel obstruction is uncommon, and making a correct diagnosis prior to surgery is often difficult. PRESENTATION OF CASE: In this case report we present a man, who suffered from sudden extreme right-sided abdominal pain. The diagnostic workup was inconclusive. Emergency surgery was indicated with a suspicion of acute appendicitis. We found a strangulated ileus caused by an internal herniation of the small intestine through a hole in the greater omentum. The patient had no history of surgery or other physical disorders explaining this finding. The obstruction was resolved and the postoperative clinical course was uncomplicated. DISCUSSION: A thorough diagnostic workup including CT scan would most probably have given the correct diagnosis. However, the clinical course and initiation of the correct treatment would have been delayed significantly. CONCLUSION: We suggest that the diagnostic workup of patients with unclear lower abdominal pain should be limited and that acute clinical symptoms require rapid laparoscopic evaluation and surgical treatment.