Atraumatic splenic rupture in a man in his 70s: unusual cause of acute abdomen and shock.

A man in his 70s presented to the emergency department with a 2 week history of abruptly worsening abdominal pain, with no history of trauma, culminating in transient loss of consciousness. Although initially stable, he rapidly deteriorated despite aggressive fluid resuscitation, with systolic blood pressure and haemoglobin measuring at 66 mm Hg and 86 g/L at their lowest, respectively. This prompted the initiation of the massive transfusion protocol due to haemorrhagic shock. The patient was urgently transferred to theatres and on surgical exploration, active bleeding from the left upper quadrant necessitated splenectomy. He recovered well postoperatively and was discharged with the appropriate prophylaxis. This case demonstrates the importance of considering atraumatic splenic rupture (ASR) in acute abdominal pain, as its vague presentation often leads to failed diagnoses. Patients require prompt stabilisation and surgical intervention. Vaccinations and lifelong prophylactic antibiotics are recommended to prevent postsplenectomy infections.