S Mozaffari, Amir Zamani, Seyed Hadi Mirhashemi, Esmaeil Hajinasrollah
Introduction: Splenic ruptures occurring without trauma are often called spontaneous or atraumatic splenic rupture. One of the uncommon causes of ASR are medicines, especially anticoagulants. Case presentation: We present an adult female with acute constant epigastric pain without any history of trauma taking prophylactic rivaroxaban. Patient had severe anemia and prolonged prothrombin and partial thromboplastin time and computed tomographic scan with intravenous contrast showed evidences of splenic rupture. We performed emergent splenectomy and discharged her after 6 days and tolerating oral diet. Discussion: Atraumatic (or spontaneous) splenic rupture is a rare and life-threatening condition. Several reports have described the association of ASR with anticoagulation therapies. Abdominal CT scan with IV contrast remains as the gold standard of diagnosis and discontinuation of oral anticoagulant and emergent surgery is the main treatment for unstable patients. Conclusion: Management of patients with ASR whilst taking a DOAC remains challenging and high degree of suspicion for splenic rupture in patients without trauma must be maintained.