Spontaneous splenic rupture in a patient with severe malaria: a case report from the Somali region of Ethiopia

Introduction and importance: Spontaneous splenic rupture (SSR) is a rare yet potentially life-threatening condition. Malaria is a significant infectious etiology of SSR, as it induces splenomegaly, thereby increasing the risk of rupture, particularly in resource-limited settings. Herein, we report a case of SSR in a 25-year-old male. Case presentation: A 25-year-old male patient presented to emergency department with fever, chills, and headache, without any antecedent history of trauma. Physical examination revealed pale conjunctiva, and the abdominal examination was initially normal; however, the following day, it showed mild abdominal distension with generalized tenderness, predominantly in the left upper quadrant. Laboratory investigations showed anemia (Hg of 9 g/dl), thrombocytopenia (platelets of 25 × 10 3 /µl). A positive rapid diagnostic test for Plasmodium falciparum . Abdominal ultrasound revealed massive hemoperitoneum and splenic rupture. Computed tomography scan demonstrated multiple branching splenic parenchymal lacerations with massive hemoperitoneum. Emergency Laparotomy was performed and splenectomy was carried out. Clinical discussion: Treatment strategies are contingent upon the patient’s stability: conservative management is appropriate for stable patients, whereas splenectomy is indicated for those who are unstable hemodynamically. Conclusion: malaria remains a significant health burden, particularly sub-Saharan Africa with rare but life-threatening complication may occur like SSR.