Rice and Sutter Journal of Medical Case Reports 2010, 4:353 http://www.jmedicalcasereports.com/content/4/1/353 consent is available for review by the Editor-in-Chief of this journal. Appendix 1 Criteria for Spontaneous Splenic Rupture - No history of trauma or unusual physical effort, either before or on retrospect questioning after surgery. - No evidence of disease that may affect the spleen. - No evidence of perisplenic adhesions or scarring of the spleen to suggest trauma or previous trauma or rupture. - Other than findings of rupture and hemorrhage, the spleen should be normal on gross inspection and histologic examination. - Acute phase and convalescent sera should show no increase in viral antibody titers suggestive of recent infection with types associated in splenic involvement. Appendix 2 Proposed Mechanisms to Explain Idiopathic Rupture - Localized involvement of the spleen with a patho- logic process, which is no longer apparent on rupture - Reflex spasm of splenic vein causing acute splenic congestion - Portal venous congestion with chronic splenic congestion - Abnormally mobile spleen producing torsion and finally rupture - Rupture of a degenerative or aneurysmal splenic artery - Forgotten or unnoticed trauma - Sudden increase in abdominal pressure leading to rupture Abbreviations ALT: alanine aminotransferase; AST: aspartate aminotransferase; CBC: complete blood count; CT: computed tomography; DEET: N,N-Diethyl-meta- toluamide; EBV: Epstein-Barr virus; LFT: liver function test; LUQ: left upper quadrant; RBC: red blood cell; WBC: white blood cell. Acknowledgements The authors would like to thank the Internal Medicine, Pathology and Family Medicine staff of Naval Hospital Camp Pendleton for their support and guidance in caring for this patient. We would also like to personally acknowledge LCDR Aaron R. Huber, DO, and CAPT Robert W. Brinsko, MD, of the Department of Pathology, Naval Medical Center San Diego, both of whom provided clarification and guidance throughout the editing of this case report. Author details 1Branch Medical Clinic, Marine Corps Air Station Miramar, 19871 Mitscher Way, San Diego, CA 92145, USA. 2Naval Health Clinic Great Lakes, Department of Family Medicine, 3001A Sixth Street, Great Lakes, IL 60088, USA. Page 5 of 5 Authors’ contributions JPR and CMS both directly took part in patient care and contributed to data acquisition, research, manuscript conception, drafting and writing of the manuscript. JR was responsible for final editing and submission. Both authors have read and approved the final manuscript. Competing interests The authors declare that they have no competing interests. Received: 19 November 2009 Accepted: 5 November 2010 Published: 5 November 2010 References 1. 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