Mini Reviews

Spontaneous rupture of a normal spleen: a case report and literature review

Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Published: 17 December 2025
359
Views
106
Downloads

Authors

Spontaneous spleen rupture is a rare condition that occurs in less than 1% of cases without any identifiable underlying medical issues. Emergency clinicians should always include spontaneous spleen rupture in the differential diagnosis of abdominal pain, as timely diagnosis and intervention are crucial for improving patient prognosis and preventing fatal outcomes. Clinical manifestations may include pain in the epigastric region or the left upper quadrant, tachycardia, and shock. Some patients may show signs of an acute abdomen upon physical examination while maintaining stable vital signs. Point-of-care ultrasound and abdominal computed tomography play a pivotal role in the diagnosis. Standard guidelines for the treatment have not been established. While splenectomy remains the mainstay of treatment, some selected hemodynamically stable patients may be suitable candidates for splenic artery embolization. In this minireview, we will begin by discussing the case of a 53-year-old man who experienced left lower back pain for five days, initially misdiagnosed as renal colic, and we will then conclude by examining the current literature on this important topic.

Downloads

Download data is not yet available.

Citations

1. Powers RD, Guertler AT. Abdominal pain in the ED: stability and change over 20 years. Am J Emerg Med 1995;13:301-3. DOI: https://doi.org/10.1016/0735-6757(95)90204-X
2. Smith ME, Mukubwa NR, Powers RD. Abdominal pain in the emergency department: 50 years on. Am J Emerg Med 2025;92:135-137. Erratum in: Am J Emerg Med 2025;92:257. DOI: https://doi.org/10.1016/j.ajem.2025.03.062
3. Debnath D, Valerio D. Atraumatic rupture of the spleen in adults. J R Coll Surg Edinb 2002;47:437-45.
4. Renzulli P, et al. Systematic review of atraumatic splenic rupture. Br J Surg 2009;96:1114-21.. DOI: https://doi.org/10.1002/bjs.6737
5. Laseter T, McReynolds T. Spontaneous splenic rupture. Mil Med 2004;169:673-4. DOI: https://doi.org/10.7205/MILMED.169.8.673
6. Imbert P, Rapp C, Buffet PA. Pathological rupture of the spleen in malaria: analysis of 55 cases (1958-2008). Travel Med Infect Dis 2009;7:147-59. DOI: https://doi.org/10.1016/j.tmaid.2009.01.002
7. Julià J, Canet JJ, Lacasa XM, González G, Garau J. Spontaneous spleen rupture during typhoid fever. Int J Infect Dis 2000;4:108-9. DOI: https://doi.org/10.1016/S1201-9712(00)90104-8
8. Vergne R, Selland B, Gobel FL, Hall WH. Rupture of the spleen in infective endocarditis. Arch Intern Med 1975;135:1265-7. DOI: https://doi.org/10.1001/archinte.1975.00330090137017
9. de Souza LJ, de Azevedo J, Kohler LIA, et al. Evidence of dengue virus replication in a non-traumatic spleen rupture case. Arch Virol 2017;162:3535-9. DOI: https://doi.org/10.1007/s00705-017-3527-6
10. Marcos-Ramírez ER, Treviño-García LA, Téllez-Aguilera A, et al. Spontaneous splenic rupture, an unusual presentation of tuberculosis. Cir Cir 2021;89:1-5. DOI: https://doi.org/10.24875/CIRU.20000756
11. Ballardini P, Incasa E, Del Noce A, et al. Spontaneous splenic rupture after the start of lung cancer chemotherapy. A case report. Tumori 2004;90:144-6. DOI: https://doi.org/10.1177/030089160409000129
12. Habib E, Elhadad A, Slama JL. Diagnosis and treatment of spleen rupture during pancreatitis. Gastroenterol Clin Biol 2000;24:1229-32.
13. Li N, Wang JC, Zhu MH, et al. Pathologic diagnosis of spontaneous splenic rupture in systemic lupus erythematosus. Int J Clin Exp Pathol 2013;6:273-80.
14. Giagounidis AA, Burk M, Meckenstock G, et al. Pathologic rupture of the spleen in hematologic malignancies: two additional cases. Ann Hematol 1996;73:297-302. DOI: https://doi.org/10.1007/s002770050245
15. Ayoub M, Mabrouk MY, Abdelouahab H, et al. Chronic lymphocytic leukemia, a rare cause of spontaneous rupture of the spleen. Int J Surg Case Rep 2022;96:107315. DOI: https://doi.org/10.1016/j.ijscr.2022.107315
16. Trabulsi NH, Alshammakh SS, Shabkah AA, et al. Spontaneous rupture of spleen in a patient with COVID-19 disease: case report and review of the literature. J Surg Case Rep 2022;2022:rjac124. DOI: https://doi.org/10.1093/jscr/rjac124
17. Lucido FS, Nesta G, Gambardella C, et al. Atraumatic splenic rupture in COVID-19 era: case report and systematic literature review. Minerva Surg 2023;78:86-91. DOI: https://doi.org/10.23736/S2724-5691.22.09718-0
18. Smaadahl N, Rüber F, Bosbach S, Martig F. Atraumatic splenic rupture associated with COVID-19. BMJ Case Rep 2023;16:e253399. DOI: https://doi.org/10.1136/bcr-2022-253399
19. Melamed MT, Gigliotti JL. Atraumatic spontaneous splenic rupture in a female COVID-19 patient. J Osteopath Med 2022;122:481-5. DOI: https://doi.org/10.1515/jom-2021-0291
20. Shaukat I, Khan R, Diwakar L, et al. Atraumatic splenic rupture due to covid-19 infection. Clin Infect Pract 2021;10:100042. DOI: https://doi.org/10.1016/j.clinpr.2020.100042
21. Knefati M, Ganim I, Schmidt J, et al. COVID-19 With an Initial Presentation of Intraperitoneal Hemorrhage Secondary to Spontaneous Splenic Rupture. Cureus 2021;13:e15310. DOI: https://doi.org/10.7759/cureus.15310
22. Mobayen M, Yousefi S, Mousavi M, Shafighi Anbaran A. The presentation of spontaneous splenic rupture in a COVID-19 patient: a case report. BMC Surg 2020;20:220. DOI: https://doi.org/10.1186/s12893-020-00887-5
23. Isel I, Serin I, Kal Kolik B, et al. A COVID-19 mystery: multisystem inflammatory syndrome in adults (MIS-A) associated with splenic rupture. New Microbiol 2023;46:81-5.
24. Agus M, Ferrara ME, Bianco P, et al. Atraumatic Splenic Rupture in a SARS-CoV-2 Patient: Case Report and Review of Literature. Case Rep Surg 2021;2021:5553619. DOI: https://doi.org/10.1155/2021/5553619
25. Bakalli I, Biqiku M, Cela D, et al. Atraumatic splenic rupture in a child with COVID 19. BMC Pediatr 2022;22:300. DOI: https://doi.org/10.1186/s12887-022-03353-8
26. Azar F, Brownson E, Dechert T. Cocaine-associated hemoperitoneum following atraumatic splenic rupture: a case report and literature review. World J Emerg Surg 2013;8:33. DOI: https://doi.org/10.1186/1749-7922-8-33
27. Carlin F, Walker AB, Pappachan JM. Spontaneous splenic rupture in an intravenous drug abuser. Am J Med 2014;127:e7-8. DOI: https://doi.org/10.1016/j.amjmed.2013.09.035
28. Toubia NT, Tawk MM, Potts RM, Kinasewitz GT. Cough and spontaneous rupture of a normal spleen. Chest 2005;128:1884-6. DOI: https://doi.org/10.1378/chest.128.3.1884
29. Lennard TW, Burgess P. Vomiting and 'spontaneous' rupture of the spleen. Br J Clin Pract 1985;39:407-10. DOI: https://doi.org/10.1111/j.1742-1241.1985.tb07873.x
30. Kaufman N, Ferraro D. Splenic rupture following synchronised direct current cardioversion. BMJ Case Rep 2017;2017:bcr2017221288. DOI: https://doi.org/10.1136/bcr-2017-221288
31. Jabr F, Skeik N. Spleen rupture complicating upper endoscopy. Endoscopy 2012;44:E206. DOI: https://doi.org/10.1055/s-0032-1308924
32. Famularo G, Minisola G, De Simone C. Rupture of the spleen after colonoscopy: a life-threatening complication. Am J Emerg Med 2008;26:834.e3-4. DOI: https://doi.org/10.1016/j.ajem.2008.01.024
33. Cullinane C, Gudyma J, McArdle G. Emergency splenectomy postelective colonoscopy. BMJ Case Rep 2017;2017:bcr2016219083. DOI: https://doi.org/10.1136/bcr-2016-219083
34. Bracale U, Merola G, Lazzara F, et al. Spleen rupture: an unusual postoperative complication after laparoscopic cholecystectomy. Ann Ital Chir 2013;84:S2239253X13021166.
35. Mertens M, Verheyen L, Ceulemans J. Spontaneous splenic rupture two days after laparoscopic sleeve gastrectomy. Acta Chir Belg 2025;125:100-2. DOI: https://doi.org/10.1080/00015458.2024.2424047
36. Parker R, Gravante G, Elshaer M, et al. Spontaneous splenic rupture four days after an open appendicectomy. Ann R Coll Surg Engl 2015;97:e23-4. DOI: https://doi.org/10.1308/003588414X14055925060550
37. Bahli ZM, Kennedy K. Post hysterectomy spontaneous rupture of spleen. J Ayub Med Coll Abbottabad 2009;21:181-3.
38. Carey R, Nelatur V. Spontaneous splenic rupture secondary to dabigatran: the last in a series of unfortunate events. Clin Med 2018;18:406–8. DOI: https://doi.org/10.7861/clinmedicine.18-5-406
39. Labaki ML, De Kock M. Atraumatic splenic rupture in a patient treated with rivaroxaban: A case report and a narrative review. Clin Case Rep 2022;10:e6462. DOI: https://doi.org/10.1002/ccr3.6462
40. Basnet S, Mohanty E, Mir I, et al. Atraumatic splenic rupture associated with apixaban. SAGE Open Med Case Rep 2019;7:2050313X19832490. DOI: https://doi.org/10.1177/2050313X19832490
41. Camacho E. Splenic rupture: with consideration of the so-called spontaneous rupture of normal spleen. Henry Ford Hosp Med Bull 1959;7:30-9.
42. Badenoch DF, Maurice HD, Gilmore OJ. Spontaneous rupture of a normal spleen. J R Coll Surg Edinb 1985;30:326-7.
43. Lieberman ME, Levitt MA. Spontaneous rupture of the spleen: a case report and literature review. Am J Emerg Med 1989;7:28-31. DOI: https://doi.org/10.1016/0735-6757(89)90079-X
44. Choudhury AK. Spontaneous rupture of a normal spleen. Injury 2004;35:325-6. DOI: https://doi.org/10.1016/S0020-1383(03)00238-9
45. Allen TL, Greenlee RR, Price RR. Delayed splenic rupture presenting as unstable angina pectoris: case report and review of the literature. J Emerg Med 2002;23:165-9. DOI: https://doi.org/10.1016/S0736-4679(02)00486-9
46. Sforza C, Margelli M, Mourad F, et al. Spontaneous spleen rupture mimicking non-specific thoracic pain: A rare case in physiotherapy practice. Physiother Theory Pract 2023;39:641-9. DOI: https://doi.org/10.1080/09593985.2021.2021578
47. Orloff MJ, Peskin GW. Spontaneous rupture of the normal spleen; a surgical enigma. Int Abstr Surg 1958;106:1-11.
48. Crate ID, Payne MJ. Is the diagnosis of spontaneous rupture of a normal spleen valid? J R Army Med Corps 1991;137:50-1. DOI: https://doi.org/10.1136/jramc-137-01-12
49. Diamond T, Bateson PG. Use of ultrasound scanning in diagnosis and conservative management of rupture of the spleen. Injury 1987;18:411-2. DOI: https://doi.org/10.1016/0020-1383(87)90291-9
50. Ma OJ, Mateer JR, Ogata M, et al. Prospective analysis of a rapid trauma ultrasound examination performed by emergency physicians. J Trauma 1995;38: 879–85. DOI: https://doi.org/10.1097/00005373-199506000-00009
51. Shokoohi H, Boniface KS, Pourmand A, et al. Bedside ultrasound reduces diagnostic uncertainty and guides resuscitation in patients with undifferentiated hypotension. Crit Care Med 2015;43:2562–9. DOI: https://doi.org/10.1097/CCM.0000000000001285
52. Wang Y, Cao R, Ye N, et al. Efficacy evaluation of different conservative treatments for blunt spleen rupture. Minerva Med 2021;112:615-21. DOI: https://doi.org/10.23736/S0026-4806.20.06574-X
53. Tomaselli GF, Mahaffey KW, Cuker A, et al. 2017 ACC expert consensus decision pathway on management of bleeding in patients on oral anticoagulants: a report of the American College of Cardiology Task Force on expert consensus decision pathways. J Am Coll Cardiol 2017;70:3042–67. DOI: https://doi.org/10.1016/j.jacc.2017.09.1085
54. Hadary A, Dashkovsky I, Rapaport A, Cozakov JC. Non-traumatic rupture of spleen: can splenectomy be applied selectively? Isr Med Assoc J 2008;10:889-91.
55. Raikhlin A, Baerlocher MO, Asch MR, Myers A. Imaging and transcatheter arterial embolization for traumatic splenic injuries: review of the literature. Can J Surg 2008;51:464–72.
56. Kocael PC, Simsek O, Bilgin IA, et al. Characteristics of patients with spontaneous splenic rupture. Int Surg 2014;99:714-8. DOI: https://doi.org/10.9738/INTSURG-D-14-00143.1
57. Moore EE, Cogbill TH, Jurkovich GH, et al. Organ injury scaling: spleen and liver (1994 revision). J Trauma 1995;38:323–4. DOI: https://doi.org/10.1097/00005373-199503000-00001

How to Cite



Spontaneous rupture of a normal spleen: a case report and literature review. (2025). Emergency Care Journal. https://doi.org/10.4081/ecj.2025.14521