Splenic rupture is most commonly caused by abdominal trauma and both immediate and delayed ruptures after traumatic events have been described in the literature [1] [2]. The exact pathogenesis of a delayed rupture is not known, with expanding subcapsular hematomas, clotting events, and rupture of pseudocysts/pseudoaneurysms being the main theories [3]. On the other hand, non-traumatic splenic rupture (NSR) is rare, but can be seen in a range of disorders [1] [2] [4] [5] [6]:

• Infections - Infectious mononucleosis (caused by Epstein-Barr virus - EBV) and malaria are two important diseases in which splenic rupture is a well-known complication [1] [2] [5].
• Surgery-induced - Colonoscopy, emergency laparoscopy, and various types of abdominal surgery [2] [4].
• Iatrogenic - Use of thrombolytic drugs, anticoagulants and recombinant granulocyte-colony stimulating factor (G-CSF) [2].

In addition, several tumors (angiosarcomas, hematologic malignancies), pregnancy-related events, and intrinsic splenic disease (infarction, development of pseudocysts, etc.) have been mentioned as possible etiologies [2]. The clinical presentation may start abruptly or approximately 4-8 days after the injury in the case of delayed rupture [3] [7]. Upper left quadrant abdominal pain accompanied by generalized distension and tenderness is the main symptom, followed by tachycardia, hypotension, oliguria, pallor, and hypovolemic shock [1] [3] [5] [6]. Splenic rupture is particularly dangerous in neonates when bleeding and severe hemoperitoneum follows abdominal distention [8]. When trauma is the reason for splenic rupture, other injuries may be observed, such as lower rib fractures overlying the spleen (seen in up to 40% of cases) [3].

As splenic ruptures carry a life-threatening risk (up to 9% of infectious mononucleosis patients) [5], the diagnosis must be made as soon as possible. A combination of clinical, laboratory and imaging studies are necessary [1], starting with a properly obtained patient history that will point to a traumatic or non-traumatic cause. The physical examination may be even more important if conducted thoroughly, and the presence of a palpable tender mass in the upper left quadrant of the abdomen (known as the Ballance's sign), as well as referred left shoulder pain due to irritation of the diaphragm (the Kehr's sign) are highly suggestive of a splenic pathology [6]. Laboratory studies include a basic biochemical panel and a complete blood count (CBC), which will often show a decreased hematocrit [3]. Imaging studies, however, are pivotal for making the diagnosis. Abdominal ultrasonography is a highly useful first-line procedure that can be done bedside if patients are unstable [1], but a computed tomography (CT) scan should be performed whenever possible [1] [4]. Aspiration of fresh blood from the peritoneum is another diagnostic indicator of splenic rupture [1].

The treatment for a splenic rupture depends on the severity of the injury. In mild cases, conservative management with close monitoring, bed rest, and pain control may be sufficient. However, severe cases often require surgical intervention. This can involve repairing the spleen or, in some cases, removing it entirely (a procedure known as a splenectomy). Blood transfusions may also be necessary to replace lost blood.

The prognosis for a splenic rupture varies based on the severity of the rupture and the timeliness of treatment. With prompt medical attention, many patients recover fully, especially if the spleen can be preserved. However, if the spleen is removed, patients may be at increased risk for infections and may require vaccinations and prophylactic antibiotics to prevent illness.

Splenic rupture can occur due to various causes. Traumatic injuries, such as those from car accidents or sports injuries, are common causes. Non-traumatic causes include medical conditions like infectious mononucleosis, which can enlarge the spleen and make it more susceptible to rupture. Certain blood disorders and cancers can also increase the risk of splenic rupture.

Splenic rupture is relatively rare but can occur in individuals of any age. It is more commonly associated with trauma, particularly in young adults and those involved in high-impact sports. Non-traumatic splenic ruptures are less common and are often related to underlying medical conditions.

The spleen is a highly vascular organ, meaning it has a rich blood supply. When it ruptures, blood can leak into the abdominal cavity, leading to internal bleeding. The extent of the rupture and the amount of bleeding can vary, influencing the severity of symptoms and the urgency of treatment required.

Preventing splenic rupture primarily involves minimizing the risk of trauma. This includes wearing seat belts in vehicles, using protective gear during sports, and avoiding activities that could lead to abdominal injury. For individuals with conditions that enlarge the spleen, regular medical check-ups and following medical advice can help reduce the risk.

Splenic rupture is a serious condition that requires prompt medical attention. It can result from trauma or underlying medical conditions and presents with symptoms like abdominal pain and signs of shock. Diagnosis involves imaging studies, and treatment ranges from observation to surgery. With timely intervention, the prognosis is generally favorable, although removal of the spleen can increase infection risk.

If you suspect a splenic rupture, it is important to seek immediate medical care. Symptoms like severe abdominal pain, dizziness, and confusion should not be ignored. Treatment may involve surgery, and recovery can vary based on the severity of the rupture. If the spleen is removed, additional precautions may be necessary to prevent infections. Always follow your healthcare provider's advice and attend follow-up appointments to ensure proper recovery.

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6. Roche M, Maloku F, Abdel-Aziz TE. An unusual diagnosis of splenic rupture. BMJ Case Rep. 2014;2014:bcr2014204891.
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