A unique case of atraumatic splenic haematoma likely caused by increased intra- abdominal pressure: a case report
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Title
A unique case of atraumatic splenic haematoma likely caused by increased intra- abdominal pressure: a case report
Subject
Splenic haematoma, Intra-abdominal pressure, Atraumatic
Description
Abstract
Background The spleen is a highly vascular organ, and splenic haematoma is a complication most commonly
due to abdominal trauma. Atraumatic splenic haematoma is much rarer and is often associated with underlying
pathology such as coagulopathies, malignancies, anatomical abnormalities or use of anticoagulants. This case report
highlights a unique case of atraumatic splenic haematoma in a young, healthy male, likely precipitated by increased
intra-abdominal pressure from persistent cough and weightlifting. It presents a rare cause of atraumatic splenic
haematoma that is not commonly documented in literature.
Case presentation The patient is a 21-year-old male, with no known chronic disease. He is a smoker and complained
of a persistent cough for the past three months. He presented the day after a gym session, with sudden left
hypochondrium tenderness with no history of trauma, vomiting or diarrhoea. Physical exam revealed normal vital
signs and generalized involuntary guarding over the entire abdomen. Initial point-of-care ultrasound was negative for
free fluid in the abdomen, but a repeat ultrasound three hours later turned positive. Computed tomography scans of
the abdomen, pelvis and mesenteric angiogram were then performed. They revealed intraperitoneal blood, a Grade
III splenic haematoma involving the superior pole of the spleen towards the inferior pole, but no active bleeding. The
patient was admitted for close monitoring. Initial laboratory evaluation did not show any coagulopathy or infection.
The patient remained hemodynamically stable throughout his inpatient stay, and was managed conservatively with
rest, analgesia, and empirical antibiotics. Serial haemoglobin levels remained stable, and his symptoms resolved
with analgesia. As he remained hemodynamically stable, no repeat imaging was performed inpatient. He was
subsequently discharged with instructions to avoid strenuous activities for 4 to 6 weeks. An outpatient follow-up was
arranged for him, to review symptoms and monitor haemoglobin level.
Conclusion This case highlights a rare case of atraumatic splenic haematoma, possibly related to increased intra-
abdominal pressure from persistent coughing and weightlifting. Atraumatic splenic haematoma is rare and might
be easily overlooked as a diagnosis in the emergency department. Emergency physicians should maintain a high
index of suspicion for splenic injury in patients presenting with unexplained left hypochondrium pain, and bedside
ultrasonography can aid in assessment and guide the need for further evaluation.
Keywords Splenic haematoma, Intra-abdominal pressure, Atraumatic
Background The spleen is a highly vascular organ, and splenic haematoma is a complication most commonly
due to abdominal trauma. Atraumatic splenic haematoma is much rarer and is often associated with underlying
pathology such as coagulopathies, malignancies, anatomical abnormalities or use of anticoagulants. This case report
highlights a unique case of atraumatic splenic haematoma in a young, healthy male, likely precipitated by increased
intra-abdominal pressure from persistent cough and weightlifting. It presents a rare cause of atraumatic splenic
haematoma that is not commonly documented in literature.
Case presentation The patient is a 21-year-old male, with no known chronic disease. He is a smoker and complained
of a persistent cough for the past three months. He presented the day after a gym session, with sudden left
hypochondrium tenderness with no history of trauma, vomiting or diarrhoea. Physical exam revealed normal vital
signs and generalized involuntary guarding over the entire abdomen. Initial point-of-care ultrasound was negative for
free fluid in the abdomen, but a repeat ultrasound three hours later turned positive. Computed tomography scans of
the abdomen, pelvis and mesenteric angiogram were then performed. They revealed intraperitoneal blood, a Grade
III splenic haematoma involving the superior pole of the spleen towards the inferior pole, but no active bleeding. The
patient was admitted for close monitoring. Initial laboratory evaluation did not show any coagulopathy or infection.
The patient remained hemodynamically stable throughout his inpatient stay, and was managed conservatively with
rest, analgesia, and empirical antibiotics. Serial haemoglobin levels remained stable, and his symptoms resolved
with analgesia. As he remained hemodynamically stable, no repeat imaging was performed inpatient. He was
subsequently discharged with instructions to avoid strenuous activities for 4 to 6 weeks. An outpatient follow-up was
arranged for him, to review symptoms and monitor haemoglobin level.
Conclusion This case highlights a rare case of atraumatic splenic haematoma, possibly related to increased intra-
abdominal pressure from persistent coughing and weightlifting. Atraumatic splenic haematoma is rare and might
be easily overlooked as a diagnosis in the emergency department. Emergency physicians should maintain a high
index of suspicion for splenic injury in patients presenting with unexplained left hypochondrium pain, and bedside
ultrasonography can aid in assessment and guide the need for further evaluation.
Keywords Splenic haematoma, Intra-abdominal pressure, Atraumatic
Creator
Yu Xian Wong1,2*, Yi Wen Mathew Yeo1
and Eleazar Ebreo1
and Eleazar Ebreo1
Date
2025
Contributor
Peri Irawan
Format
pdf
Language
english
Type
text
Files
Collection
Citation
Yu Xian Wong1,2*, Yi Wen Mathew Yeo1
and Eleazar Ebreo1, “A unique case of atraumatic splenic haematoma likely caused by increased intra- abdominal pressure: a case report,” Repository Horizon University Indonesia, accessed April 20, 2026, https://repository.horizon.ac.id/items/show/13272.