Abstract
Laparoscopic sleeve gastrectomy (LSG) is one of the most frequently performed bariatric procedures worldwide due to its efficacy in achieving significant and sustained weight loss. While generally safe, rare but life-threatening complications can occur. This case report describes a 54-year-old female who presented with acute left-sided abdominal pain and hemodynamic instability six months after an otherwise uneventful LSG. She was found to have a delayed spontaneous splenic rupture secondary to a chronic gastric staple line leak. Following urgent surgical intervention with splenectomy, the patient's condition initially improved but persistent abdominal collections and ongoing pain prompted further investigation, ultimately revealing a small staple line defect. Endoluminal vacuum therapy (EVT) and prolonged intravenous antibiotics were required. This case emphasizes the importance of maintaining a high index of suspicion for delayed postoperative complications such as chronic staple line leaks and their potential to precipitate rare events like spontaneous splenic rupture. Early recognition, prompt surgical intervention, and appropriate multidisciplinary management are critical in preventing catastrophic outcomes.