The Case Files

A 65-year-old man presented to the emergency department with sudden-onset left-sided abdominal pain and seizure-like episodes. He had a history of various non-cancerous conditions and was taking multiple medications. His vital signs were stable, and physical examination revealed tenderness in the left upper quadrant of the abdomen. Laboratory findings were mostly within normal ranges, but a CT scan showed a large hematoma in the spleen with subcapsular and perisplenic components, suggesting atraumatic splenic rupture (ASR). He was diagnosed with ASR and managed conservatively with close observation and later referred for potential underlying solid tumor metastasis-related rupture. ASR is a rare and potentially life-threatening condition that can be idiopathic or pathologic, with neoplasms and infections being common causes. It often presents with abdominal pain, tachycardia, and hypotension, and is usually diagnosed with a CT scan. While most cases are treated surgically, this patient was treated conservatively and referred for further follow-up. The document emphasizes the importance of considering ASR in the differential diagnosis for patients presenting with acute abdominal pain without trauma.