A unique case of atraumatic splenic haematoma likely caused by increased intra-abdominal pressure: a case report.

Background: The spleen is a highly vascular organ, and splenic haematoma is a complication most commonly due to abdominal trauma. Atraumatic splenic haematoma is much rarer and is often associated with underlying pathology such as coagulopathies, malignancies, anatomical abnormalities or use of anticoagulants. This case report highlights a unique case of atraumatic splenic haematoma in a young, healthy male, likely precipitated by increased intra-abdominal pressure from persistent cough and weightlifting. It presents a rare cause of atraumatic splenic haematoma that is not commonly documented in literature.

Case presentation: The patient is a 21-year-old male, with no known chronic disease. He is a smoker and complained of a persistent cough for the past three months. He presented the day after a gym session, with sudden left hypochondrium tenderness with no history of trauma, vomiting or diarrhoea. Physical exam revealed normal vital signs and generalized involuntary guarding over the entire abdomen. Initial point-of-care ultrasound was negative for free fluid in the abdomen, but a repeat ultrasound three hours later turned positive. Computed tomography scans of the abdomen, pelvis and mesenteric angiogram were then performed. They revealed intraperitoneal blood, a Grade III splenic haematoma involving the superior pole of the spleen towards the inferior pole, but no active bleeding. The patient was admitted for close monitoring. Initial laboratory evaluation did not show any coagulopathy or infection. The patient remained hemodynamically stable throughout his inpatient stay, and was managed conservatively with rest, analgesia, and empirical antibiotics. Serial haemoglobin levels remained stable, and his symptoms resolved with analgesia. As he remained hemodynamically stable, no repeat imaging was performed inpatient. He was subsequently discharged with instructions to avoid strenuous activities for 4 to 6 weeks. An outpatient follow-up was arranged for him, to review symptoms and monitor haemoglobin level.

Conclusion: This case highlights a rare case of atraumatic splenic haematoma, possibly related to increased intra-abdominal pressure from persistent coughing and weightlifting. Atraumatic splenic haematoma is rare and might be easily overlooked as a diagnosis in the emergency department. Emergency physicians should maintain a high index of suspicion for splenic injury in patients presenting with unexplained left hypochondrium pain, and bedside ultrasonography can aid in assessment and guide the need for further evaluation.