Causes of Splenic Rupture
Splenic rupture can be caused by both traumatic and non-traumatic factors, with trauma being the most common etiology, while non-traumatic or spontaneous ruptures are less frequent but carry significant mortality risks.
Traumatic Causes
- Blunt abdominal trauma is the most common cause of splenic rupture, including motor vehicle accidents, falls from height, and direct blows to the left thorax or abdomen 1
- Even trivial trauma can lead to delayed splenic rupture, occurring days to weeks after the initial injury 2
- Internal trauma such as severe coughing or vomiting can cause splenic rupture in some cases 3
Non-Traumatic (Spontaneous) Causes
Infectious Conditions
- Infectious diseases are the most common cause of non-traumatic splenic rupture, with infectious mononucleosis (Epstein-Barr virus) being the most frequent 4, 3
- Other infectious causes include malaria, HIV, and various bacterial infections 3
Hematologic Disorders
- Various hematologic malignancies and disorders can lead to splenic rupture, including leukemias, lymphomas, and myeloproliferative disorders 3
- Coagulopathies and blood disorders that cause splenomegaly increase rupture risk 3, 5
Neoplastic Conditions
- Primary or metastatic tumors of the spleen can cause rupture 3
- Non-hematologic neoplasms account for a significant portion of spontaneous splenic ruptures 3
Medication-Related
- Anticoagulants and thrombolytic medications are associated with increased risk of splenic rupture 3
- Recombinant granulocyte colony-stimulating factor (G-CSF) has been implicated in some cases 3
Procedural Causes
- Colonoscopy is the most frequently reported procedure associated with splenic rupture 3
- Other endoscopic procedures, abdominal surgeries, and cardiac surgeries have been reported to cause splenic rupture 3
Anatomical Abnormalities
- Splenic cysts, infarctions, and hamartomas can predispose to rupture 3
- Splenic artery aneurysms and peliosis (blood-filled cysts in the spleen) increase rupture risk 3
Inflammatory and Infiltrative Conditions
- Amyloidosis is associated with splenic rupture in multiple case reports 3
- Rheumatologic diseases can occasionally lead to splenic rupture 3
Pregnancy-Related
- Pregnancy and its complications have been associated with splenic rupture in some cases 3
Idiopathic
- True spontaneous splenic rupture without identifiable cause is extremely rare but has been documented 4, 5
- These cases present diagnostic challenges and often require emergency intervention 5, 6
Clinical Implications
- Delayed splenic rupture can occur 48 hours to several weeks after the initial trauma, with most cases happening between 4-10 days post-injury 1
- The mortality rate for delayed splenic rupture ranges from 5-15%, compared to 1% for acute rupture 1
- Patients with non-traumatic splenic rupture often present with left upper quadrant pain that may radiate to the left shoulder (Kehr's sign) 4, 5
Management Considerations
- High clinical suspicion is needed for both traumatic and non-traumatic splenic ruptures, as delayed diagnosis significantly increases mortality 4, 5
- Patients with known risk factors (hematologic disorders, infectious diseases, anticoagulant use) should be monitored closely if they present with abdominal pain 3
- Even in cases of trivial trauma, clinicians should maintain awareness of the possibility of delayed splenic rupture 2