Atraumatic Splenic Rupture as the Initial Manifestation of Splenic Marginal Zone Lymphoma: A Case Report.

Atraumatic splenic rupture (ASR) is a rare but life-threatening emergency that is often linked to previously unrecognized systemic disease, including hematologic malignancies. We report the case of a middle-aged man who presented with sudden abdominal pain and hemodynamic instability and was found to have spontaneous splenic rupture requiring urgent hemodynamic stabilization, splenic artery embolization, and splenectomy. Histopathologic evaluation of the resected spleen revealed an underlying splenic marginal zone lymphoma (SMZL) that had not been clinically apparent before the acute event. The patient recovered well postoperatively with appropriate vaccinations and hematology follow-up. This case highlights the need to consider occult lymphoproliferative disorders in patients with spontaneous splenic rupture and underscores the importance of prompt multidisciplinary management to prevent catastrophic hemorrhage and secure a definitive diagnosis.