A traumatic or nontraumatic rupture of the spleen can result in similar clinical findings. There may be a delay in the diagnosis of a nontraumatic rupture if it is unsuspected.


Clinical features of a ruptured spleen:

(1) left upper quadrant abdominal pain

(2) left upper quadrant tenderness

(3) left upper quadrant rigidity

(4) left shoulder tip pain

(5) signs of hemorrhage (pallor, tachycardia, hypotension, oliguria)

(6) shock if intraperitoneal hemorrhage is severe

(7) variable abdominal distention

(8) bloody fluid retrieved by peritoneal paracentesis


Imaging findings (ultrasonography may be the fastest and cheapest modality):

(1) variable splenomegaly

(2) intraperitoneal fluid and/or hematoma


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