Rice and Sutter Journal of Medical Case Reports 2010, 4:353 http://www.jmedicalcasereports.com/content/4/1/353 C A S E R E P O R T JOURNAL OF MEDICAL CASE REPORTS Open Access Spontaneous splenic rupture in an active duty Marine upon return from Iraq: a case report Jason P Rice1*, Christian M Sutter2 Abstract Introduction: Atraumatic splenic rupture is a rare event that has been associated with several infectious disease processes. In the active duty military population, potential exposure to these pathogens is significant. Here we discuss the case of an active duty Marine with spontaneous splenic rupture upon return from a six-month deployment in Iraq. Case presentation: A previously healthy 30-year-old Caucasian male active duty Marine presented with abdominal pain, fever and diarrhea after deployment to Iraq in support of Operation Iraqi Freedom. Based on clinical and radiographic evidence, a diagnosis of spontaneous splenic rupture was ultimately suspected. After exploratory laparotomy with confirmation of rupture, splenectomy was performed, and the patient made a full, uneventful recovery. Histopathologic examination revealed mild splenomegaly with a ruptured capsule of undetermined cause. Conclusion: Spontaneous splenic rupture is a rare event that may lead to life-threatening hemorrhage if not diagnosed and treated quickly. Although the cause of this patient’s case was unknown, atraumatic splenic rupture has been associated with a variety of infectious diseases and demonstrates some risks the active duty military population may face while on deployment. Having an awareness of these pathogens and their role in splenic rupture, clinicians caring for military personnel must be prepared to recognize and treat this potentially fatal complication. Introduction Traumatic splenic rupture has been well documented, with an estimated 30% rate of occurrence after opera- tively managed blunt abdominal trauma [1]. Sponta- neous rupture of the spleen, however, is a rare clinical entity, and in the absence of trauma, the diagnosis and treatment of this potentially fatal complication are often delayed. Spontaneous splenic rupture has been described in the setting of known pathology, most commonly infectious and neoplastic processes affecting the reticu- loendothelial system [2]. Atraumatic rupture of the nor- mal spleen has also been reported, although its legitimacy has long been debated [1-3]. Regardless of the mechanism, patients typically present with upper abdominal pain, classically referred to the left shoulder (Kehr’s sign), with evidence of peritonitis and * Correspondence: jason.rice2@med.navy.mil 1Branch Medical Clinic, Marine Corps Air Station Miramar, 19871 Mitscher Way, San Diego, CA 92145, USA Full list of author information is available at the end of the article hemodynamic instability [3-5]. Here we present the case of a previously healthy 30-year-old Marine with atrau- matic splenic rupture upon return from Iraq. Although no definitive cause was identified, the patient’s clinical presentation suggested an infectious source. A variety of infectious pathogens are known to cause splenic enlar- gement and thus predispose to rupture. Several of these bacterial, viral and parasitic agents are endemic to the Middle East and nearby areas of military operations, pla- cing deployed personnel in these regions at risk for exposure. Case presentation A previously healthy 30-year-old Caucasian male active duty Marine reported abdominal pain, fevers and malaise on his return flight home from Iraq. The patient noted feeling well before redeployment and denied any injury or illness over the course of his six-month tour of duty, when he was stationed at a US Army installation near Baghdad. He denied any recent or remote history © 2010 Rice and Sutter; 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.