Case Presentation:

We present a 51years old with a clear medical background who presented to the emergency room with a 2 days history of dull aching pain in the left upper quadrant that radiates to the left shoulder) and abdominal examination showed tenderness and rigidity in the upper quadrant. He denied any history of trauma. The patient received anti-malaria treatment 5 days ago after he was diagnosed with malaria infection. He was tachycardic and hypotensive. The patient was resuscitated in the emergency department with iv fluids, blood transfusion, and iv antibiotics. Computed Tomography (CT) scan of the abdomen and pelvis demonstrated a 4 cm subscapular splenic hematoma with free peritoneal fluid indicating grade III splenic rupture [Fig.1]. No active bleeding or contrast extravasation was visualized. The liver appearance was remarkably normal. An attempt for conservative management was tired, but the patient had not responded to supportive treatment and an exploratory laparotomy and splenectomy were performed [Fig 2-3]. The patient had an uneventful postoperative recovery. Follow-up one month later in the outpatient department showed a return to his baseline function and he received prophylactic vaccination against pneumococcal, Neisseria, and Hemophilus. Fig 1: Computed Tomography (CT) scan of the abdomen and pelvis Fig 2: operative Specimen Showing splenic rupture Fig 3: Fig 2: operative Specimen Showing splenic rupture