Spontaneous Splenic Ruptures: A Contemporary Systematic Review.

INTRODUCTION

Spontaneous splenic rupture (SSR) is a rare, life-threatening condition. The current study aims to provide a comprehensive recent overview of SSR.

METHODS

A comprehensive search was performed in PubMed (MEDLINE), Google Scholar, and Scopus to identify relevant case reports and case series published during the last decade (January 1, 2015-July 1, 2025).

RESULTS

We identified 351 eligible studies with 400 cases of SSR. The two most common etiologies for SSR were infectious (25.6%) and neoplastic (22.9%) conditions. Drug- or treatment-related etiologies were reported in 19% of cases, and noninfectious inflammatory conditions in 14.6%. Idiopathic SSRs accounted for 4.1% of the cases. Other less frequent, noncategorized etiologies accounted for the remaining 13.7% of the cases. Abdominal pain was the most common symptom, reported in 94.6% of the patients. Overall, 74.4% of the patients were subjected to splenectomy, followed by conservative management in 12.3%, angioembolization in 10.8%, and spleen-preserving surgery in 1.3%. The overall SSR-related mortality rate was 8.7% (95% confidence interval: 6.2%-12.1%).

CONCLUSIONS

Infectious and neoplastic causes comprise the most common etiologies of SSR. Compared with previous studies the rate of drug- or treatment-related etiologies has evolved, which may be related to the wider use of antiplatelet and anticoagulant drugs, particularly novel direct oral anticoagulants. The rate of angioembolization has significantly increased, whereas splenectomy numbers have declined. Neoplastic etiology and age over 50 years were associated with higher mortality on multivariate analysis. Overall, SSR-related mortality has decreased.