Spontaneous rupture of the spleen is a well-described occurrence in many diseases, being most commonly found in malaria. Exact incidence of this complication is not clear. In this article, we discuss pathology, diagnostic approach and therapeutic options in a patient with malarial splenic rupture. Ruptures of malarial spleens do heal and attempts at splenic lavage/conservative approach should be the aim in their management. Splenectomy should be reserved for those patients with severe rupture or those with continued or recurrent bleeding.