• Olivier A Pluut, Nicole D Holman, and Steffan G J Rödel.
• Martini Ziekenhuis, afd. Intensive Care, Groningen.
• Ned Tijdschr Geneeskd. 2015 Jan 1; 159: A8392.

BackgroundA spontaneous, atraumatic splenic rupture is a splenic rupture without a history of trauma. Rupture of this type may occur in a healthy patient but may also be seen in the context of an underlying neoplastic, haematological, infectious or local inflammatory condition.Case DescriptionA 30-year-old man presented to the emergency department with acute pain in the left shoulder, thorax and upper abdomen, accompanied by signs of haemodynamic instability. No history of trauma was reported. Because the clinical symptoms could fit various abdominal and thoracic conditions, he was sent for a CT scan. This revealed a splenic rupture with haemoperitoneum. Emergency laparotomy and splenectomy were performed. Anamnestic, histopathological and other supplementary investigations revealed no indications of underlying pathology so that a diagnosis of "atraumatic idiopathic splenic rupture" was made.ConclusionIt is clinically difficult to diagnose a spontaneous, atraumatic rupture of the spleen due to the overlap in presentation with other, more common abdominal and thoracic conditions. A CT scan is essential to detect such a rupture promptly in order to provide appropriate surgical intervention.

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