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CASE REPORT
Confusion and abdominal symptoms following a rugby tackle
  1. Demetris Ioannides1,
  2. Madeleine Davies1,
  3. Stefan Kluzek2
  1. 1Medical Sciences Division, University of Oxford, Oxford, Oxfordshire, UK
  2. 2The Botnar Research Centre (NDORMS), Oxford University Hospitals, Oxford, UK
  1. Correspondence to Dr Stefan Kluzek, stefankluzek{at}doctors.org.uk

Summary

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.

  • prehospital
  • trauma
  • sports and exercise medicine
  • infectious diseases
  • ear, nose and throat/otolaryngology

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Footnotes

  • Contributors DI is the first author of the report who compiled most of the literature review and coauthored most of the text. SK is the clinician who treated the patient, compiled all the clinical information for the report and revised multiple drafts of the report. MD contributed to the literature review and also revised drafts of the report.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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