Spontaneous rupture of a normal spleen.

A 45-year-old woman was admitted with a gangrenous toe. She had a pancreatico-renal transplant for end-stage renal disease due to type I insulin dependent diabetes three years previously and had been taking immunosuppressive agents. An epidural catheter was placed to relieve the rest pain. Next day she was found to be hypotensive and tachycardic along with other features of shock. She did not have any clinical symptoms and signs initially. Urgent blood investigations were normal except for Hb of 5.0 g/dl; an ultrasound scan showed free fluid in the peritoneal cavity. Emergency laparotomy after resuscitation confirmed a massive haemoperitoneum secondary to a ruptured spleen. Histology showed loss of areas of the capsule and other areas showing subcapsular haemorrhage with no underlying pathology in the spleen.