Abstract
INTRODUCTION: Splenic rupture is a potentially life-threatening condition and most commonly linked to abdominal or thoracic trauma. When it occurs without trauma, it is termed as spontaneous splenic rupture (SSR). However, it is exceedingly rare and typically occurs secondary to underlying pathological processes. In malaria-endemic regions, Plasmodium infections can cause splenic enlargement and increase the risk of rupture. CASE PRESENTATION: We present four cases of spontaneous splenic rupture, all occurring in patients with a recent history of malaria treatment. One patient was a 30-year-old previously healthy male from a malaria-endemic region in Ethiopia who presented with acute left upper quadrant abdominal pain, dizziness, and massive hemoperitoneum, requiring an emergency splenectomy. The remaining three patients, although diagnosed with SSR, were hemodynamically stable and managed successfully with conservative treatment, including close monitoring, supportive care, and serial imaging. None of the non-operatively managed patients required surgery during follow-up. DISCUSSION: SSR due to malaria is rare but more common in endemic areas. Malaria-associated splenic rupture is due to vascular congestion, reticuloendothelial hyperplasia, and a fragile splenic capsule. A high index of suspicion is important in patients with malaria who develop abdominal pain. Such patients need proper abdominal imaging and exclusion of trauma. Treatment depends mainly on hemodynamic stability, with splenectomy reserved for uncontrolled bleeding. CONCLUSION: Malaria-related spontaneous splenic rupture may present with variable clinical severity. Early recognition, appropriate imaging, and timely surgical intervention are critical for favorable outcomes, particularly in malaria-endemic settings.