Sowers and Aubrey-Bassler Journal of Medical Case Reports 2011, 5:591 http://www.jmedicalcasereports.com/content/5/1/591 C A S E R E P O R T JOURNAL OF MEDICAL CASE REPORTS Open Access Trivial trauma and delayed rupture of a normal spleen: a case report Nicholas Sowers1 and F Kris Aubrey-Bassler2* Abstract Introduction: Although a majority of splenic ruptures present acutely with a known mechanism of injury, a minority of patients present days to weeks following trauma with a delayed rupture. Also uncommon is the atraumatic rupture, the vast majority of which occur in patients with underlying splenic pathology. A handful of cases of apparently spontaneous rupture of a normal spleen are reported; however, there is debate about whether these actually represent delayed ruptures following a history of trauma that is not elicited. Although a few cases of delayed rupture of the spleen following trivial trauma have been reported, the majority of these present evidence of an underlying disease process. We found only two such cases that documented a normal spleen and three cases where underlying splenic pathology was not reported. We review the literature and discuss the phenomenon of delayed rupture of the normal spleen following trivial trauma. Case presentation: A 27-year-old Caucasian man with no underlying splenic pathology presented with splenic rupture one week after playfully wrestling with his partner. The patient did not present at the time of the injury and only recalled it upon repeated questioning after computed tomography diagnosis. Conclusions: This case lends support to the theory that the normal spleen can rupture some time after trivial trauma, which seems like a more plausible explanation than rupture without cause. However, given the dearth of similar reports in the literature, the possibility remains that the association we have observed is not causational. Keywords: spleen, splenic rupture, wounds and injuries, delayed diagnosis, minor trauma, delayed splenic rupture Introduction In patients sustaining blunt abdominal trauma, the spleen is the most commonly damaged viscus [1]. Although a majority of patients with this injury present acutely, up to 15% present with a delayed rupture days to weeks following a substantial abdominal injury. The mortality for patients presenting with acute splenic rup- ture is approximately 1% whereas the mortality asso- ciated with delayed rupture approaches 15% [2]. While atraumatic rupture of the spleen is not unheard of, cases reported in the literature of such a rupture are rare and usually occur in a diseased spleen [3]. There is debate in the literature as to whether appar- ently atraumatic ruptures of the spleen are truly sponta- neous or actually represent a delayed rupture following a history of trauma that is not elicited at the time of * Correspondence: kaubrey@mun.ca 2Primary Healthcare Research Unit, Memorial University of Newfoundland, St. John’s, NL, Canada Full list of author information is available at the end of the article presentation (reviewed in [3]). In 1958, Orloff and Peskin proposed four criteria to define what they refer to as ‘spontaneous’ rupture of a spleen [4], which emphasizes that the spleen must appear grossly and his- tologically normal. In the same paper, they cite 71 reports documenting ruptures of the spleen labelled as spontaneous, only 20 of which fulfilled all of their cri- teria. Thus, usage of the term spontaneous was inconsis- tent and continues to be so in the more recent literature, with many authors labeling the rupture of dis- eased spleens as spontaneous. We present the case of a 27-year-old Caucasian man without risk factors for rupture and an apparently nor- mal spleen who presented with a delayed rupture and significant hemoperitoneum one week after sustaining a left sided abdominal injury. The injury was so minor that the patient did not present for assessment at the time and only recalled the incident following radiologi- cal diagnosis and subsequent questioning. We found only two cases of delayed rupture of normal spleen © 2011 Sowers and Aubrey-Bassler; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.