Splenic rupture carries a high mortality rate in the absence of an early diagnosis. It can occur due to both traumatic and non-traumatic causes. Pain in the upper left abdominal quadrant, hypotension, pallor, tachycardia and abdominal distention are main symptoms. A complete blood count revealing a decreased hematocrit and imaging studies, mainly ultrasonography and computed tomography, are used for confirmation, whereas history taking is essential for determining the underlying cause.
Splenic rupture is most commonly caused by abdominal trauma and both immediate and delayed ruptures after traumatic events have been described in the literature  . The exact pathogenesis of a delayed rupture is not known, with expanding subcapsular hematomas, clotting events, and rupture of pseudocysts/pseudoaneurysms being the main theories . On the other hand, non-traumatic splenic rupture (NSR) is rare, but can be seen in a range of disorders     :
In addition, several tumors (angiosarcomas, hematologic malignancies), pregnancy-related events, and intrinsic splenic disease (infarction, development of pseudocysts, etc.) have been mentioned as possible etiologies . The clinical presentation may start abruptly or approximately 4-8 days after the injury in the case of delayed rupture  . Upper left quadrant abdominal pain accompanied by generalized distension and tenderness is the main symptom, followed by tachycardia, hypotension, oliguria, pallor, and hypovolemic shock    . Splenic rupture is particularly dangerous in neonates when bleeding and severe hemoperitoneum follows abdominal distention . When trauma is the reason for splenic rupture, other injuries may be observed, such as lower rib fractures overlying the spleen (seen in up to 40% of cases) .
As splenic ruptures carry a life-threatening risk (up to 9% of infectious mononucleosis patients) , the diagnosis must be made as soon as possible. A combination of clinical, laboratory and imaging studies are necessary , starting with a properly obtained patient history that will point to a traumatic or non-traumatic cause. The physical examination may be even more important if conducted thoroughly, and the presence of a palpable tender mass in the upper left quadrant of the abdomen (known as the Ballance's sign), as well as referred left shoulder pain due to irritation of the diaphragm (the Kehr's sign) are highly suggestive of a splenic pathology . Laboratory studies include a basic biochemical panel and a complete blood count (CBC), which will often show a decreased hematocrit . Imaging studies, however, are pivotal for making the diagnosis. Abdominal ultrasonography is a highly useful first-line procedure that can be done bedside if patients are unstable , but a computed tomography (CT) scan should be performed whenever possible  . Aspiration of fresh blood from the peritoneum is another diagnostic indicator of splenic rupture .