Spontaneous splenic rupture without an antecedent history of trauma is an unusual entity. There have been sporadic case reports of spontaneous splenic rupture since its original 19th-century description. Since 1986, five cases of spontaneous splenic rupture have been treated at our institution. Two patients developed ruptures in apparently normal spleens. In the remaining three patients, splenic rupture was associated with infectious mononucleosis, a benign mesothelial cyst, and a dermoid cyst. Radiographic findings, etiologies, and the pertinent literature are reviewed. SPlenic rupture is a well-described entity which is typically associated with trauma and can be found in up to 30% of patients undergoing surgery for blunt abdominal trauma (1). Spontaneous (or pathologic) rupture of the spleen, however, is a relatively uncommon entity. Since 1Kokitansky's description of splenic rupture involving a leukemic patient in 1861 (2), as well as King's report of splenic rupture in a patient with infectious mononucleosis in 1941 (3), spontaneous splenic rupture has become much more widely recoguized. It has been associated with a wide variety of neoplastic, hematologic, autoimmune, and infectious diseases as well as several benign conditions. Spontaneous splenic rupture also has occasionally been reported in normal spleens (4). Since 1986, we have documented five cases of spontaneous splenic rupture. Upon pathologic examination, three of these patients had benign mesothelial cyst, dermoid cyst, and infectious mononucleosis. Two patients had apparently normal spleens. We present these five cases, as well as a review of the literature. CASE 1The patient was a 62-year-old man who presented with acute onset of lower left quadrant and epigastric pain after a meal. The patient had a past medical history significant for several previous myocardial infarctions, repair of an abdominal aortic aneurysm, and chronic renal failure. The pain was described as sharp and radiating to the left shoulder. Systolic blood pressure in the emergency department was 60 mmHg. Physical examination revealed a mildly distended abdomen with marked epigastric tenderness. Hematocrit was low at 28%. A computed tomographic (CT) scan of the abdomen revealed a splenic laceration with hemoperitoneum (Fig. 1). The patient subsequently underwent a splenectomy. Pathology demonstrated a normal-sized spleen which had an irregularly torn capsule as well as an intraparenchymal hematoma. The remainder of the splenic parenchyma was normal. CASE 2The patient was a 51-year-old woman with a remote history of ovarian carcinoma who presented after 24 hours ofepigastric and left upper quadrant pain radiating to the left shoulder. Vital signs and hematocrit on admission were normal. An abdominal CT scan, however, demonstrated splenic rupture with intraperitoneal hemorrhage. The patient was urgently brought to the operating room, where a total splenectomy was performed. Gross pathology demonstrated a torn splenic capsule as well as a subcapsular hematoma. The spleen Emergen...

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