Spontaneous Splenic Artery Rupture in a Young Adult Without Aneurysmal Disease or Known Risk Factors

Spontaneous splenic artery rupture is a rare but life-threatening cause of intra-abdominal hemorrhage that is most commonly associated with aneurysmal disease, trauma, or underlying vascular pathology. Nonaneurysmal rupture in a young adult without identifiable risk factors, aneurysmal degeneration, or diagnostic vascular findings on computed tomography angiography is exceedingly uncommon and may present a significant diagnostic challenge. We present the case of a previously healthy 27-year-old male who presented with fever, epigastric discomfort, shortness of breath, and lethargy before rapidly deteriorating into hemorrhagic shock and cardiac arrest. Computed tomography angiography demonstrated hemorrhagic ascites without evidence of aneurysmal disease, vascular abnormality, or active contrast extravasation. Emergent exploratory laparotomy revealed spontaneous rupture of the mid-splenic artery with massive hemoperitoneum. The patient underwent damage control distal pancreatectomy and splenectomy with staged re-exploration and intensive postoperative critical care management. Despite profound acidosis with a lowest recorded intraoperative arterial pH of 6.665, coagulopathy, and massive transfusion requirements, the patient survived and was discharged home on hospital day 28. This case highlights the diagnostic difficulty of spontaneous nonaneurysmal splenic artery rupture in the absence of classic risk factors or definitive imaging findings. In patients with unexplained hemoperitoneum and rapid hemodynamic deterioration, clinicians should maintain suspicion for occult visceral artery hemorrhage despite nondiagnostic vascular imaging. Early operative intervention and aggressive resuscitation remain critical for survival.