Where Sepsis Meets Haemorrhage: A Case Report of Spontaneous Splenic Rupture Following Perforated Diverticulitis

Atraumatic splenic rupture is an extremely rare cause of deterioration in the context of concurrent abdominal pathology. This case report describes rapid deterioration and shock in a mid-50s-year-old man with acute complicated sigmoid diverticulitis 3 days into admission without history of abdominal trauma. This was associated with a rapid haemoglobin (Hb) drop from 119 to 37 g/L, which necessitated activation of the massive transfusion protocol. An atraumatic splenic rupture was subsequently diagnosed on urgent exploratory laparotomy. The patient underwent splenectomy followed by a Hartmann's procedure for treatment of perforated sigmoid diverticulitis. This case highlights the importance of maintaining a broad differential diagnosis and consideration of concurrent pathologies for deteriorating patients with common acute infectious abdominal pathologies, including appendicitis or diverticulitis, as missed diagnosis of atraumatic splenic rupture may be fatal due to profound haemorrhage.