Spontaneous Splenic Rupture without Trauma: Clinical Insight from a Three-case Series

Atraumatic splenic rupture (ASR) is a rare but life-threatening event that usually occurs in diseased spleens and can complicate systemic infections. Among infectious causes, Epstein-Barr virus (EBV) is the most frequently implicated, with rupture recognized as one of the most serious complications of infectious mononucleosis. Although the incidence is estimated at only 0.1%-0.5%, mortality can reach 5%-10% if diagnosis and treatment are delayed. Patients often present with abdominal pain, hypotension, or shock, but symptoms may be subtle and mimic other acute conditions. We report three cases of ASR in older adults. Case 1 involved a 79-year-old man with sudden abdominal pain and hypotension; he deteriorated under conservative management and required emergency splenectomy. EBV serology was positive. Case 2 was a 67-year-old woman admitted with collapse and sepsis-like features; computed tomography (CT) confirmed rupture, and she underwent splenectomy followed by a complicated postoperative course. EBV polymerase chain reaction was positive. Case 3, a 73-year-old woman with recent pneumonia, presented with dizziness and abdominal/back pain; CT confirmed rupture, and she underwent splenectomy. EBV testing was not performed. Histopathology in all three showed capsular rupture with hemorrhage but no lymphoma or malignancy. Each patient received postsplenectomy vaccination and antibiotic prophylaxis. These cases highlight the variable presentation of ASR, including EBV-associated forms, and emphasise the pivotal role of CT in diagnosis and the frequent need for splenectomy in unstable patients. Vigilance, rapid imaging, and adherence to postsplenectomy prophylaxis are critical for improving survival in this uncommon but serious condition.