Medico-legal difficulties in a death due to delayed traumatic rupture of massive sarcoid spleen with rivaroxaban therapy.

Splenic rupture is a potentially fatal event, most frequently associated with blunt abdominal trauma. We hereby present an unusual post-mortem case of delayed splenic rupture occurring 5.5 days after a single punch to the chest. The case was further complicated by massive sarcoid splenomegaly and rivaroxaban therapy prescribed for prior deep vein thrombosis. Detailed histopathological examination of an overlying rib fracture and an organizing splenic hematoma revealed healing changes entirely consistent with the reported injury timeframe. The combined effects of trauma, underlying granulomatous disease, and anticoagulation contributed to progressive subcapsular splenic hemorrhage, ultimately resulting in delayed capsular rupture and fatal hemoperitoneum. Integration of histological evidence with the documented timeline of the assault enabled the Crown Prosecution Service to pursue a manslaughter charge against the alleged assailant. This case highlights the challenges of establishing causality when a significant interval separates trauma from death.