Systematic review of atraumatic splenic rupture

Br J Surg. 2009 Oct;96(10):1114-21. doi: 10.1002/bjs.6737.


Background: Atraumatic splenic rupture (ASR) is an ill defined clinicopathological entity.

Methods: The aim was to characterize aetiological and risk factors for ASR-related mortality in order to aid disease classification and treatment. A systematic literature review (1980-2008) was undertaken and logistic regression analysis employed.

Results: Some 632 publications reporting 845 patients were identified. The spleen was normal in 7.0 per cent (atraumatic-idiopathic rupture). One, two or three aetiological factors were found in 84.1, 8.2 and 0.7 per cent respectively (atraumatic-pathological rupture). Six major aetiological groups were defined: neoplastic (30.3 per cent), infectious (27.3 per cent), inflammatory, non-infectious (20.0 per cent), drug- and treatment-related (9.2 per cent) and mechanical (6.8 per cent) disorders, and normal spleen (6.4 per cent). Treatment comprised total splenectomy (84.1 per cent), organ-preserving surgery (1.2 per cent) or conservative measures (14.7 per cent). The ASR-related mortality rate was 12.2 per cent. Splenomegaly (P = 0.040), age above 40 years (P = 0.007) and neoplastic disorders (P = 0.008) were associated with increased ASR-related mortality on multivariable analysis.

Conclusion: The condition can be classified simply into atraumatic-idiopathic (7.0 per cent) and atraumatic-pathological (93.0 per cent) splenic rupture. Splenomegaly, advanced age and neoplastic disorders are associated with increased ASR-related mortality.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Epidemiologic Methods
  • Female
  • Humans
  • Male
  • Middle Aged
  • Rupture, Spontaneous / etiology
  • Rupture, Spontaneous / mortality
  • Rupture, Spontaneous / therapy
  • Splenic Rupture / etiology*
  • Splenic Rupture / mortality
  • Splenic Rupture / therapy
  • Splenomegaly / complications
  • Splenomegaly / mortality
  • Young Adult