Spontaneous splenic rupture is a rare ill-defined clinicopathological entity and occurs in only 1% of all splenic ruptures. It occurs usually as a result of splenic infiltration by infectious or hematological diseases. We present a case of 36-year-old female who was admitted to our emergency department with a three-hour history of acute onset abdominal pain and dyspnea. There was no history of trauma and infectious or hematological diseases. Considering the hemodynamic instability an emergent laparotomy was performed. During laparotomy, a 5-cm splenic laceration was found and a splenectomy was performed. The histology report confirmed that there was no pathological cause of splenic rupture.

Keywords: Acute abdomen, Atraumatic splenic rupture, Splenectomy

Spontaneous splenic rupture is a life-threatening abdominal emergency. Spontaneous splenic rupture without a history of trauma is very uncommon [1]. It occurs in only 1% of all splenic ruptures. Atraumatic splenic rupture usually occurs due to infectious, hematological, or malignant infiltration of spleen [2]. Its etiology and management are unclear [3] . Nonetheless, emergency splenectomy is the standard treatment for patient with spontaneous splenic rupture [4].

A 36-year-old female was admitted to our emergency department with a three-hour history of acute onset abdominal pain and dyspnea. There was no history of trauma and infectious or hematological diseases. On examination, her pulse was 88/minutes with systolic blood pressure 85/60 mmHg, oxygen saturation of 95%. There was guarding over the left hypochondrium and epigastrium. Initial blood tests showed hemoglobin of 7.8 g/dl, hematocrit of 23.9% with normal coagulation profile. Abdominal sonography showed presence of free fluid around the spleen. Computed tomography scan confirmed the peri-splenic hematoma (Figure 1). The patient was monitored in our clinic. Intravenous fluids and empirical antibiotics were given. A total of two units of red blood cells were given. Repeat blood tests showed hemoglobin of 7.5 g/dl, hematocrit of 23.3%. Considering the hemodynamic unstability and persistent pain, surgical intervention was decided. Laparotomy revealed 3000 cc of blood in the abdomen and a 5-cm splenic laceration were found. During the surgery a total of three units of red blood cells and three units of fresh frozen plasma were given. A splenectomy was performed. She was discharged with no problem on day-4. The histology report confirmed that there was no pathological cause of splenic rupture.

Spontaneous splenic rupture occurs mostly in a spleen due to infectious hematological or malignant infiltration. Spontaneous splenic rupture without a history of trauma is an uncommon entity. This serious clinical event which warrants immediate intervention is mostly in the form of operative surgery to save life [2][5]. In spite of that, it has been reported in literature that a less invasive approach as proximal splenic artery embolization may be a safe, successful therapeutic alternative in selected patients [6].

In conclusion, spontaneous splenic rupture without a history of trauma is an uncommon life-threatening abdominal emergency. The pathogenesis of the disease remains unclear. In patients with atraumatic left hypochondrial pain and low hemoglobin, splenic rupture should be kept in mind.

1. Chan RS, Abdul Aziz YF, Chandran P, Ng EK. Splenic amyloidosis: A rare cause of spontaneous splenic rupture. Singapore Med J 2011 Nov;52(11):e232–5.   [Pubmed]    
2. Thapar PM, Philip R, Masurkar VG, Khadse PL, Randive NU. Laparoscopic splenectomy for spontaneous rupture of the spleen. J Minim Access Surg 2016 Jan–Mar;12(1):75–8.   [CrossRef]   [Pubmed]    
3. Renzulli P, Hostettler A, Schoepfer AM, Gloor B, Candinas D. Systematic review of atraumatic splenic rupture. Br J Surg 2009 Oct;96(10):1114–21.   [CrossRef]   [Pubmed]    
4. Elghanmi A, Mohamed J, Khabouz S. Spontaneous splenic rupture in pregnancy. Pan Afr Med J 2015 Aug 28;21:312.   [Pubmed]    
5. Mohammed AM, Majid ZI, Villatoro EA. Spontaneous rupture of the spleen as a result of primary splenic lymphoma. J Surg Case Rep 2016 Jan 1;2016(1). pii: rjv164.   [CrossRef]   [Pubmed]    
6. Bellingham GA, Kribs S, Kornecki A, Scott L, Leaker M, Fraser DD. Proximal splenic artery embolization in the management of splenic rupture. Pediatr Crit Care Med 2009 Jan;10(1):e1–4.   [CrossRef]   [Pubmed]