Occult ruptured spleen--two unusual clinical presentations.

Case reports of two patients with occult rupture of the spleen are presented. In one, blunt trauma appeared to involve only the neck and upper chest, resulting in two distinct tracheal injuries and no clinical indication of abdominal injury. On the 5th day after injury this patient strangulated an indirect inguinal hernia. At subsequent surgery, a ruptured spleen was also found. The second patient gave no history of trauma and presented in cardiac and respiratory failure after a 2-month illness characterized by abdominal pain. On clinical and biochemical assessments, he was considered to have pancreatitis complicated by pseudocyst formation. Laparotomy revealed intra-abdominal haemorrhage and a ruptured spleen. The diagnosis and complications of occult ruptured spleen are discussed.