[Clinical thinking and decision-making in the practice. A young man in shock]

A previously healthy male aged 32 years with noticeably long extremities went into shock whilst straining to defaecate. He did not lose consciousness and reported pain high in the back and in the abdomen. Transoesophageal echocardiography revealed no abnormalities. Ultrasonography of the abdomen showed blood in the abdominal cavity, following which laparotomy was performed. An aneurysm of the splenic artery was found to have ruptured. The aneurysm and the spleen were removed. Morbid-anatomical examination showed no vascular abnormalities. The postoperative course was uneventful.