Identification and management of nontraumatic splenic rupture

Area of Science:

• Emergency Medicine
• Radiology
• Gastroenterology

Background:

• A 43-year-old male with no significant past medical history presented with acute epigastric pain.
• The patient experienced preceding coryzal symptoms, suggesting a possible viral prodrome.

Observation:

• The patient was hemodynamically stable upon arrival at the emergency department (ED).
• Initial ultrasound (US) in the ED was inconclusive regarding intra-abdominal fluid.
• Physical examination revealed a tender abdomen and a hemoglobin level of 9.2 g/dL.

Findings:

• Computerized tomography (CT) scan demonstrated extensive high-density fluid within the peritoneal cavity.
• The imaging findings raised suspicion for a concealed intra-abdominal bleed.
• No definitive source of bleeding was identified on the CT scan.

Implications:

• This case highlights the diagnostic challenge of occult intra-abdominal hemorrhage in the absence of a clear source.
• Further investigation may be warranted to determine the etiology of the unexplained fluid and bleeding.
• Consideration of less common causes of intra-abdominal bleeding is important in emergency settings.