To the Editor.—Spontaneous rupture of the normal spleen is rare without serious trauma but has been reported after apparently trivial insults such as jogging, squash, cycling, and electroconvulsive therapy. We report such a case.
Report of a Case. 44-year-old woman with bronchitis had severe pain under the left costal margin after a paroxysm of coughing. She denied any trauma. Her pulse was 120 beats per minute and BP, 60 mm Hg. The abdomen was rigid, with involuntary guarding and tenderness in the left upper quadrant. The laboratory data at admission were normal, except for a leukocyte count of 17,400/cu mm.
Laparotomy showed 3,000 mL of blood and a large, splenic, subcapsular hematoma. The abdominal viscera were ptotic. Exploration showed no other abnormality. The spleen weighed 135 g and was histologically normal. No evidence of other systemic disease was observed. Repeated questioning for history of trauma was negative. The patient