DOI: https://doi.org/10.36347/sjmcr.2026.v14i10.001

Pages: 2112-2118

Atraumatic splenic rupture is a rare but potentially lethal cause of haemoperitoneum which, in more than nine out of ten cases, is the first manifestation of an underlying splenic or systemic disease. We report the case of a 28-year-old man with no medical history who was admitted to the emergency department for acute pain of the left hypochondrium occurring without any trauma, fall, sporting activity or recent invasive procedure. He was haemodynamically stable, with a blood pressure of 130/60 mmHg and a heart rate of 90 beats per minute, and had no peritoneal signs. Contrast-enhanced thoraco-abdomino-pelvic computed tomography (CT) demonstrated splenomegaly measuring 17 cm in long axis with a heterogeneous parenchyma, several lacerations more than 3 cm deep, an intraparenchymal haematoma of the upper pole, foci of splenic infarction, and a dense intraperitoneal effusion in the perisplenic space, the paracolic gutters and the pelvis, consistent with haemoperitoneum. The blood count on admission showed a haemoglobin concentration of 14.1 g/dL contrasting with profound thrombocytopenia at 5,000/mm³, leucocytosis of 22,100/mm³, C-reactive protein of 295 mg/L and ferritin of 4,943 ng/mL. An extensive aetiological work-up comprising viral serologies, blood cultures, autoimmune screening and protein electrophoresis identified no infectious or autoimmune cause; Epstein-Barr virus serology showed a profile of past rather than acute infection. Because the patient remained haemodynamically stable with no evidence of active bleeding, non-operative management was chosen, combining intensive monitoring, correction of the thrombocytopenia with the haematology team, multimodal analgesia and serial blood counts. Follow-up CT showed stable splenic lesions, no active bleeding and regression of the haemoperitoneum, and the patient was discharged on day 10 with his spleen preserved.