Splenic rupture

Last updated: November 6, 2023

Summarytoggle arrow icon

Injury to the spleen is most often the result of blunt abdominal trauma. In rare cases, it may also be caused by spontaneous rupture from an infection or a hematological condition. A ruptured spleen may result in massive intra-abdominal bleeding and should therefore be treated as a medical emergency. Rupture of the spleen may be acute or delayed: acute rupture, in which the patient immediately presents in severe pain and shock, is differentiated from a delayed rupture, which presents with sudden onset of pain and shock following a symptom-free interval lasting days to weeks. Depending on the severity of the injury, conservative therapy with observation in a high dependency unit may be considered, but most patients require surgical intervention. A splenic salvage maneuver (i.e., suturing, coagulation) is performed when possible; however, a splenectomy is commonly indicated in extensive injury involving the splenic hilum and may be a lifesaving procedure.

Etiologytoggle arrow icon

Traumatic splenic rupture [1]

Atraumatic splenic rupture [2]

Pathophysiologytoggle arrow icon

  • Anatomy
  • Mechanisms of splenic rupture
    • Acute rupture: injury of the splenic capsule and possibly the splenic parenchymal tissue → acute intra-abdominal bleeding
    • Delayed rupture: injury of the splenic parenchymal tissue in an initially intact splenic capsule → central or subcapsular hematomaasymptomatic interval (days to weeks) as hematoma distends inside the capsule → subsequent capsular rupture with intra-abdominal bleeding

Clinical featurestoggle arrow icon

It is important to identify signs of any other major life-threatening injury in a polytrauma patient! (see blunt abdominal trauma for details)

Diagnosticstoggle arrow icon

Repeated ultrasound examination is crucial, especially in conservative management of splenic rupture!

  • In hemodynamically stable patients (or in unstable patients in which temporary stabilization with IV fluid resuscitation is successful)
  • Always consider other organs that could be injured (see “Differential diagnosis” below)

Differential diagnosestoggle arrow icon


The differential diagnoses listed here are not exhaustive.

Treatmenttoggle arrow icon

Splenectomy is a lifesaving procedure for hemodynamically unstable patients with continuous bleeding!

Complicationstoggle arrow icon

Complications of splenic rupture

Complications of splenectomy

Overwhelming post-splenectomy infection is a potentially life-threatening complication.

We list the most important complications. The selection is not exhaustive.

Referencestoggle arrow icon

  1. Subedi N. Liver and Spleen Injuries and Associated Rib Fractures: An Autopsy Study. J Forensic Res. 2014; 05 (05).doi: 10.4172/2157-7145.1000240 . | Open in Read by QxMD
  2. Renzulli P, Hostettler A, Schoepfer AM, Gloor B, Candinas D. Systematic review of atraumatic splenic rupture. Br J Surg. 2009; 96 (10): p.1114-1121.doi: 10.1002/bjs.6737 . | Open in Read by QxMD
  3. Dave A, Dhand H, Mujalde A. Spontaneous Rupture of Spleen During Pregnancy. The Journal of Obstetrics and Gynecology of India. 2012; 62 (6): p.692-693.doi: 10.1007/s13224-012-0141-0 . | Open in Read by QxMD
  4. Rowell SE, Biffl WL, Brasel K, et al. Western Trauma Association Critical Decisions in Trauma: Management of adult blunt splenic trauma - 2016 updates. J Trauma Acute Care Surg. 2017; 82 (4): p.787-793.doi: 10.1097/ta.0000000000001323 . | Open in Read by QxMD
  5. Stassen NA, Bhullar I, Cheng JD, et al. Selective nonoperative management of blunt splenic injury. J Trauma Acute Care Surg. 2012; 73 (5): p.S294-S300.doi: 10.1097/ta.0b013e3182702afc . | Open in Read by QxMD
  6. Coccolini F, Montori G, Catena F, et al. Splenic trauma: WSES classification and guidelines for adult and pediatric patients. World J Emerg Surg. 2017; 12 (1).doi: 10.1186/s13017-017-0151-4 . | Open in Read by QxMD
  7. Aydin Y, Ulas AB, Eroglu A. Subphrenic Abscess. Springer International Publishing ; 2020: p. 745-750
  8. Reed JC. Elevated Diaphragm. Elsevier ; 2018: p. 63-70
  9. Saxena AK, Grewal H. Pediatric Abdominal Trauma. Pediatric Abdominal Trauma. New York, NY: WebMD. Updated: August 14, 2015. Accessed: December 5, 2016.
  10. Frost, JL. Children and Injuries. Lawyers and Judges ; 2001

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