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American Journal of  Medical 
Science and Innovation (AJMSI) 

Primary Spontaneous Splenic Rupture: A Rare and Life-Threatening Condition
Ahmed Anaizi1*, Othman Al-Dabbagh2

Volume 2 Issue 2, Year 2023
ISSN: 2836-8509 (Online)

DOI: https://doi.org/10.54536/ajmsi.v2i2.2122
https://journals.e-palli.com/home/index.php/ajmsi

Article Information ABSTRACT

Received: October 07, 2023
Accepted: November 03, 2023
Published: November 07, 2023

This case report outlines the presentation, diagnosis, and management of  a 26-year-old 
male with primary spontaneous splenic rupture, a highly uncommon clinical condition. 
Primary spontaneous splenic rupture necessitates a high index of  suspicion for accurate 
diagnosis. Diagnostic Imaging, particularly abdominal CT scans, is pivotal in its detection. 
This case underscores the critical importance of  timely recognition and intervention. 
Clinicians should consider various inflammatory, neoplastic, and infectious etiologies in 
the differential diagnosis of  splenic rupture. Physical examination revealed tenderness 
and guarding, predominantly in the left upper quadrant and left flank. Laboratory findings 
indicated an elevated white blood cell count, predominantly polymorphonuclear leukocytes. 
Contrast-enhanced CT scan showed substantial free fluid in the acute abdomen, with 
high density observed around the liver and spleen. Exploratory laparotomy confirmed 
hemoperitoneum and spontaneous splenic rupture. This case report highlights the rarity 
of  primary spontaneous splenic rupture and emphasises the significance of  early detection 
and intervention. Through examination and advanced imaging techniques, clinicians can 
accurately diagnose and promptly manage this life-threatening condition.

Keywords
Splenic Rupture, Acute Abdomen, 
Hemoperitoneum, Diagnostic 
Imaging, Laparotomy

1 Internal Medicine, Mediclinic Hospital, Abu Dhabi, UAE
2 Surgical Department, Marbella Medical Center, Al-Ain, Abu Dhabi, UAE
* Corresponding author’s e-mail: ahmedanaizi011@outlook.com

INTRODUCTION
Primary spontaneous splenic rupture, an infrequently 
encountered but exceptionally critical medical 
phenomenon, signifies the abrupt and atraumatic rupture 
of  a previously unremarkable spleen (Borio et al., 2022). 
Atraumatic splenic rupture, though rare, poses a potentially 
life-threatening situation. Unlike traumatic cases, this 
occurrence involves splenic rupture in the absence of  any 
external force or injury (Bona, 2020). Unlike secondary 
ruptures, which are often precipitated by trauma or 
underlying pathologies, this condition manifests without 
any apparent antecedent cause, presenting a diagnostic 
problem for healthcare providers (Wu et al., 2022). This 
enigmatic presentation can encompass a spectrum of  
symptoms, often bereft of  overt clinical indicators, 
further complicating the diagnostic process (Bain, 2023). 
The potential for severe bleeding and its associated 
complications confers a pressing need for a swift and 
precise diagnosis, underscoring the urgency of  timely 
intervention (Saceleanu et al., 2023).
A comprehensive review of  845 cases from the available 
literature revealed the primary factors leading to 
hypersplenism, which include neoplastic conditions such 
as leukaemia and lymphoma, accounting for 30 per cent, 
infections like infectious mononucleosis, cytomegalovirus 
(CMV), HIV, endocarditis, and malaria contributing to 27 
per cent, and inflammatory diseases or non-infectious 
disorders like acute and chronic pancreatitis making up 20 
per cent, additionally, drug and treatment-related causes, 
such as anticoagulation, granulocyte colony-stimulating 
factor (G-CSF), thrombolytic therapy, and dialysis, 
were identified in 9 per cent of  cases (Onyango et al., 
2023). Mechanical factors, including pregnancy-related 
conditions and congestive splenomegaly, constituted 

7 per cent, while idiopathic cases with a normal spleen 
accounted for the same percentage; the overall mortality 
rate was 12 per cent, with risk factors for mortality 
encompassing splenomegaly, age over 40 years, and the 
presence of  a neoplastic disorder, of  the cases, 84 per cent 
underwent splenectomy. At the same time, conservative 
measures were adopted for the remaining cases (Renzulli 
et al., 2009).
This intriguing case report serves as a stark reminder of  
the critical need to consider spontaneous splenic rupture 
in patients experiencing acute abdominal pain, especially in 
the absence of  any traumatic events. The enigmatic nature 
of  this condition, devoid of  apparent antecedent causes, 
presents a diagnostic puzzle for healthcare providers. 
Timely recognition and intervention are paramount in 
navigating this complex medical scenario, ultimately 
holding the key to favorable outcomes for those grappling 
with this rare and potentially life-threatening ailment.

Case Presentation
The patient, a 26-year-old male, arrived at the Al-Noor 
hospital’s emergency room on June 1st, 2011, seeking 
urgent medical attention for acute and distressing 
abdominal pain. The patient was having discomfort, which 
had emerged abruptly the previous night and had since 
evolved into a progressively diffuse sensation, significantly 
causing pain by even the slightest movement; lying down 
provided relief  to the patient. Notably, he also experienced 
an episode of  emesis, which was described as non-coffee 
ground in nature, and had one loose bowel movement. 
Encouragingly, there was no indication of  fresh blood 
in either the emesis or the stool, alleviating concerns of  
gastrointestinal bleeding. The patient denied any history of  
fever or chills, pointing towards an afebrile state.



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In addition to the abdominal discomfort, the patient 
explained the alarming circumstances of  symptoms 
and reported feelings of  giddiness accompanied by a 
pronounced sense of  weakness. These sensations were 
coupled with palpitations, indicating potential cardiac 
involvement. The patient noted sweating, which further 
highlighted the severity and distressing nature of  his 
condition. Moreover, He reported no known allergies, 
was a non-smoker and non-alcoholic, and worked as a 
policeman. He was married and had one healthy child.
This study indicated mild erosive esophagitis and 
gastroduodenitis, both of  which had shown improvement 
with esomeprazole therapy. The patient’s medical history 
revealed epigastric pain and dyspepsia, which had been 
thoroughly evaluated through endoscopy in September 
2008. Remarkably, the patient had been asymptomatic for 
the past two years and denied any significant recent or 
past traumas. 
On initial examination, the patient appeared pale, 
apprehensive and had a dry mouth. Notably, there were 
no signs of  jaundice, clubbing, or palmar erythema. 
Palpable lymph nodes were absent. Vital signs recorded a 
blood pressure of  120/70mmHg in the supine position, 
which dropped to 80/40 upon standing, associated with 
pre-syncope. The heart rate was 103 beats per minute, 
regular, with a respiratory rate of  19 breaths per minute. 
Oxygen saturation was 99%, and temperature was within 
normal range at 37°C.
CNS examination revealed intact function, while 

abdominal examination indicated diffuse tenderness with 
guarding, more pronounced in the left upper quadrant 
and left flank. Organomegaly was difficult to check due 
to the tenderness. There were no abnormal masses or 
bruising observed, and the hernial orifice was free.
Later, Laboratory investigations provided crucial insights 
into the patient’s haematological and biochemical profile. 
Haemoglobin level was measured at 12.3g/dl, indicating 
a normal range, which is (12.1 to 15.1 g/dL) but slightly 
lowered haemoglobin concentration. Hematocrit 
registered at 36%, demonstrating a balanced proportion 
of  red blood cells in the blood volume. The red blood 
cell count was 4.4 million/ml, aligning with standard 
physiological ranges. White blood cell count, however, 
presented as elevated at 14,500 cells/ml.
Further differentiation revealed a predominance of  
polymorphonuclear leukocytes, accounting for 63% of  
the total count. Lymphocytes constituted 30%, monocytes 
were present at 5%, while basophils and eosinophils made 
up trace amounts. These findings indicated a heightened 
inflammatory response, potentially suggestive of  an acute 
pathological process.
Additionally, biochemical analyses showed no significant 
abnormalities; results were in the normal range. Notably, 
liver function tests, including SGOT, SGPT, and alkaline 
phosphatase, were within normal limits. Serum amylase 
was also normal. Electrolytes, including potassium, 
sodium, and chloride, were within physiological ranges. 
Laboratory examination results are presented in Table 1.

Table 1: Laboratory Examination Results
Laboratory Examination Results Normal Range
Hb 12.3 g/dl 12.1 to 15.1 g/dL
Ht 36% 41% to 50%
Red Blood Cell Count 4.4mill/ml 4.7 mill/ml to 6.1 mill/ml
WBC 14500 4500 to 11,000
PMN 63% 40% to 65%
LYMPH 30% 20% to 40%
MONO 5% 2% to 8%
BASO, EOSINO 1% Baso: 0.5% to 1%, Eosino: 1% to 4%
MCV 82.4 80–100
MCH 27.1 27 to 31
MCHC 33.8% 32–36%
PLT 455,000 150,000 to 450,000
B. Urea 29 mg/dl 5 to 20 mg/dl
Creatinine 0.6 mg/dl 0.74 to 1.35 mg/dL
SGOT 17 8 to 45
SGPT 20 7 to 56
ALP 74 44 to 147
Amylase 92 40 to 140
Pottasium 4.1 mmol/l 3.5 to 5.5
Sodium 142 mmol/l 135 to 145
Chloride 112 96 to 106
Bilirubin 0.42 0.1 to 1.2



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As mentioned in Figure 1, a CT scan of  the abdomen 
and pelvis was performed, which revealed significant free 
fluid in the abdominal cavity, with high density observed 
around the liver, spleen, flanks, and pelvis. There was 
no evidence of  intra-abdominal or retroperitoneal 
mass lesions. Based on the imaging findings, the patient 
underwent an explorative laparotomy, which confirmed 
the diagnosis of  hemoperitoneum. Intraoperatively, 
blood clots were predominantly found in the upper 
abdomen, around the omentum and spleen, with evidence 
of  blood oozing near the splenic hilum. Consequently, a 
splenectomy was performed to address the spontaneous 
rupture of  the spleen.
The histopathology report revealed that the pre-
operative diagnosis of  acute abdominal bleeding was 
confirmed through examination of  the specimens. The 

first specimen consisted of  a single piece of  fatty tissue 
displaying severe haemorrhage throughout, measuring 6 
x 4 x 0.5 cm. This sample was meticulously sectioned, 
and various parts were processed (Block x2). The second 
specimen, the spleen, was intact and measured 11 x 5.5 
x 2 cm. It was appropriately sectioned and underwent 
partial processing (Block x4). Upon microscopic 
examination, the first specimen revealed matured fatty 
tissue with extensive, fresh haemorrhage pervading 
nearly the entire field. No atypia or signs of  malignancy 
were observed. The examination of  the splenic tissue 
in the second specimen unveiled notable infiltration of  
neutrophilic cells in the subcapsular region and along 
the tear’s edges, accompanied by multiple areas of  
intraparenchymal haemorrhage. Additionally, moderate 
lymphoid hyperplastic changes were noted. As with the 
first specimen, no atypia or malignancy indicators were 
detected. These histopathological features align closely 
with the clinical impression of  a traumatic splenic tear or 
rupture. There was no evidence of  atypia or malignancy 
in either specimen. The histopathology report is shown 
in Figure 2.
Post-splenectomy was crucial to implement measures 
to mitigate the risks associated with functional asplenia, 
which included vaccination against encapsulated 
pathogens, prophylactic antibiotics, and vigilant 
monitoring for potential complications. In this case, 
the surgery was prescribed to treat the patient. The 
case emphasises the importance of  heightened clinical 
awareness to facilitate prompt diagnosis and surgical 
intervention in cases of  primary spontaneous splenic 
rupture, a rare but potentially life-threatening condition. Figure 1: CT-Scan Results

Figure 2: Histopathology Report



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DISCUSSION
Primary spontaneous splenic rupture is an exceedingly 
rare clinical entity, with only a limited number of  
cases reported in the literature. The condition poses a 
diagnostic challenge due to its elusive presentation and 
absence of  antecedent traumatic events. Spontaneous 
splenic rupture, while a rare phenomenon, commands 
immediate attention and precise diagnosis owing to 
its potentially fatal consequences. This case report 
underscores the critical importance of  recognising and 
promptly addressing this life-threatening condition. 
This classic presentation aligns with previous reports of  
primary spontaneous splenic rupture (Borio et al., 2022). 
The absence of  fever or chills, along with the lack of  
a history of  trauma, further supports the diagnosis of  
atraumatic splenic rupture.
As mentioned in Table 1, laboratory investigations 
revealed an elevated white blood cell count, predominantly 
composed of  polymorphonuclear leukocytes. This 
finding is consistent with an acute inflammatory process, 
which is commonly observed in cases of  splenic rupture 
(Borio et al., 2022; Wu et al., 2022).
As shown in Figure 1, Imaging played a pivotal role in 
the diagnosis of  primary spontaneous splenic rupture. 
The contrast-enhanced CT scan revealed significant free 
fluid in the abdominal cavity, with high density observed 
around the liver, spleen, flanks, and pelvis. This imaging 
finding corroborated the clinical suspicion and guided 
subsequent surgical intervention. The role of  CT scans 
in detecting splenic rupture has been emphasised in 
previous studies (Bain, 2023; Saceleanu et al., 2023).
In Figure 2, the histopathological examination of  the spleen 
confirmed the diagnosis, revealing notable infiltration of  
neutrophilic cells along the tear’s edges, along with areas 
of  intraparenchymal haemorrhage. These findings are 
consistent with the clinical impression of  a traumatic 
splenic rupture; no evidence of  atypia or malignancy was 
detected, further supporting the diagnosis of  primary 
spontaneous splenic rupture (Crowley et al., 2021).
The aetiology of  spontaneous splenic rupture remains 
elusive, with various theories proposed yet lacking 
robust empirical support; these conjectures range from 
localised splenic pathologies obliterating evidence upon 
rupture to reflex splenic vein spasms causing acute 
congestion, Chronic portal venous congestion, recurrent 
torsions in mobile spleens, and potential ruptures of  
degenerative splenic arteries further contribute to the 
complexity, Notably, spontaneous splenic rupture has 
been documented in a spectrum of  medical conditions, 
historical cases, from Rokitansky in 1861 to Atkinson in 
1874, provide context (Dunphy et al., 2019). 
The diagnostic landscape in cases of  spontaneous splenic 
rupture is notoriously challenging, primarily due to its 
symptomatic resemblance to an array of  acute abdominal 
conditions (Bax et al., 2022). The absence of  a history 
of  trauma related to the classic signs of  abdominal pain 
and guarding raised concern for the healthcare team. 
Furthermore, the presence of  high-density free fluid 

surrounding vital organs, as presented in the CT scan, 
strongly suggested bleeding or pus, compelling the medical 
team to opt for explorative laparotomy (Hoeg, 2022).
Despite advancements in medical science, the precise 
aetiology of  spontaneous splenic rupture remains an 
enigma in many instances; theorised causes ranging 
from reflex spasm of  the splenic vein to portal venous 
congestion and an abnormally mobile spleen only 
add layers to the diagnostic challenge, distinguishing 
spontaneous splenic rupture from other causes of  acute 
abdominal pain, including gastrointestinal and cardiac 
conditions, demands a nuanced approach (YaÄŸmurkaya 
et al., 2021). 
Clinicians must maintain a vigilant stance, keeping 
spontaneous splenic rupture on their diagnostic radar, 
especially when presented with classic symptoms. 
Surgical intervention, such as splenectomy or partial 
splenectomy, remains the mainstay of  treatment, 
although non-operative management may be considered 
in this case. Additionally, it is important to address any 
underlying predisposing conditions, such as infectious 
mononucleosis or hematologic disorders, to prevent 
recurrence (Lin et al., 2022). 
The presented case serves as a reminder of  the 
complexities inherent in medical diagnoses and ensuring 
the well-being of  patients facing rare and challenging 
conditions like spontaneous splenic rupture.

CONCLUSION
In conclusion, this case of  spontaneous splenic rupture 
underscores the need for heightened clinical awareness 
and interdisciplinary collaboration in rare medical 
emergencies. Advanced imaging and collaboration among 
specialists play a transformative role in diagnosis and 
management. Understanding diverse etiologies and post-
splenectomy complications equips clinicians to deliver 
timely and highly effective care. This Study ensures 
optimal patient outcomes and guides future research and 
innovation in rare medical conditions.

Strengths and Limitations
This report offers a thorough clinical presentation and 
supports the diagnosis with histopathological evidence. It 
effectively places the case in context with existing literature, 
emphasising the need for early intervention. However, 
due to the rarity of  the condition, generalizability may be 
restricted. The study is based on a single case, and long-
term follow-up is absent.

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