Management of spontaneous atraumatic splenic rupture in the setting of anticoagulation: case report and literature review

A 69-year-old male with a history of atrial fibrillation on apixaban with no recent history of trauma presented with acute onset abdominal pain and hypotension with no identified precipitating event. Intraabdominal free fluid was noted on bedside ultrasound, and computed tomography angiography of the abdomen showed splenic rupture. Anticoagulation was reversed with prothrombin complex, and he was taken to the operating room for emergent splenectomy. Spontaneous splenic rupture is uncommon, but as with traumatic splenic injuries, it may be managed operatively or non-operatively. In patients on therapeutic anticoagulation, reversal agents should be considered. Spontaneous splenic rupture may lead to life-threatening hemorrhage, particularly for patients on therapeutic anticoagulation. This case highlights the importance of timely diagnosis and operative intervention as well as the role of anticoagulation reversal for these patients.