Clinical Practice and Cases in Emergency Medicine

A 79-year-old female called 911 for abdominal pain in her left upper quadrant with radiationthrough to her back and left shoulder for three hours. Upon arrival to the emergency departmenther physical exam was positive only for tenderness in the left upper quadrant of her abdomen.The patient denied any history of trauma but reported she “did sneeze three times” just priorto the onset of her pain. Computed tomography angiography of the abdomen and pelvis wasobtained to evaluate for vascular pathology. The radiologist immediately called with concern forsplenic laceration. The general surgeon took the patient directly to the operating room whereshe underwent a splenectomy and recovered without sequelae. This is the first case report ofspontaneous splenic rupture that resulted after the act of sneezing. It is important to be aware ofthis rare clinical entity because early recognition can be life saving.