Although rupture of the spleen usually presents with a classic clinical picture1 of a patient in shock with profuse intraperitoneal bleeding requiring splenectomy as a life-saving procedure either immediately (85%) or as a delayed rupture (14%) producing hemorrhage days, or even weeks after the injury, such circumstances are not always present. A small number of patients survive major rupture of the spleen which is undiagnosed and untreated, an entity which has recently been recognized as occult rupture of the spleen.
Acute rupture of spleen 85% Delayed rupture of spleen 14% Occult rupture of spleen <1% This entity is of significance because the patient may present with a confusing variety of signs and symptoms masquerading variously as angina or myocardial infarction, pulmonary embolism with pleural effusion, intraperitoneal malignancy with a palpable mass, a retroperitoneal sarcoma or a blood dyscrasia. The correct diagnosis in the few reported cases in the literature
Drapanas T, Yates AJ, Brickman R, Wholey M. The Syndrome of Occult Rupture of the Spleen. Arch Surg. 1969;99(3):298-306. doi:10.1001/archsurg.1969.01340150006002