the spleen is the most vascular organ of the body , with a blood flow of 350 l / day . it can hold up to 1.5 l of blood in total , making it a reservoir of 30% of the total blood volume . splenic hematomas with subsequent calcification or immediate rupture are most commonly the result of blunt abdominal trauma . however , atraumatic hematomas of the spleen , which constitute 23% of cases , may result from a multitude of systemic diseases which may be infectious , hematologic , neoplastic or infiltrative in nature . we present a case of chronic idiopathic spleen hematoma that was discovered incidentally , and treated electively with laparoscopic splenectomy , with no abnormal histological findings on pathologic examination of spleen . a 24-year - old woman with negative medical and surgical history , complaining of epigastric discomfort and associated nausea and occasional vomiting underwent abdominal ultrasound evaluation for suspicion of gallstone disease . the ultrasound results , further confirmed by computed tomography ( ct ) scan ( fig . 1a  c ) , revealed a large 16  12 cm splenic cystic mass . she was referred to poissy hospital ( paris ) for surgical management of the splenic cystic tumor . the decision was made to perform laparoscopic splenectomy , with high suspicion of splenic hydatid cyst . preoperative laboratory workup including complete blood count , parasitic serologies and chemistries were within normal limits . pneumovax 23 23-valent pneumococcal polysaccharide vaccine was administered 2 weeks prior to the planned splenectomy . under general anesthesia , with the patient in the right decubitus position in reverse flexion , another 5 mm trocar was inserted in the left sub - xiphoid area and a 5 mm trocar was inserted in the sub - costal mid axillary line . exploration of the abdomen revealed a large splenic mass occupying the left flank and the epigastrium , covered with patchy white membranes . the rest of the spleen was lying posterior and inferior to the tumor and no other abnormalities were detected . using echelon endopath , a white endostapler , the splenocolic ligament was dissected exposing the left gastroepicloic artery , which was clipped and cut . the splenic vasculature was of bundled type with one major splenic artery , which was identified superior to the splenic vein . both were dissected , clipped and cut making sure to preserve the pancreatica magna artery . then dissection was carried on along the greater curvature of the stomach , where the short gastric were also cut . in order to completely mobilize the spleen , a small hole was punctured into the wall of the cyst , through which 1.1 l of chocolate - colored liquid was entirely contained and suctioned to be sent for cytology followed by extensive irrigation with cetrimide ensuring no contamination . a fragment of the wall was sent to frozen section and was histologically identified as organized calcified hematoma with negative cytology . the spleen and the remainder of the cystic tumor were removed through a small incision in the left lower quadrant . the patient received prophylactic antibiotic treatment with 1.2 g of amoxicillin / clavulanic acid ( augmentin ) ivdrip every 12 h for six doses and the drain was removed on the fifth postoperative day . figure  1:ct scan of the abdomen and pelvis without contrast , showing the 16 cm splenic cyst with partially calcified rim . ( a ) coronal view , ( b ) saggital view , ( c ) cross - sectional view . ct scan of the abdomen and pelvis without contrast , showing the 16 cm splenic cyst with partially calcified rim . ( a ) coronal view , ( b ) saggital view , ( c ) cross - sectional view . traumatic hemorrhage or rupture of a normal spleen is a common result of high velocity trauma . a pathologic splenic hematoma is less frequently encountered secondary to diseases affecting the reticuloendothelial system ( epstein  barr virus infection , cytomegalovirus infection , hepatitis , malaria ) or neoplasia ( lymphoma , leukemia ) . spontaneous hematoma formation with possible rupture of the normal spleen has been a subject of controversy since the first case reported by atkinson ( 1874 ) . guided by those criteria , we found no history of trauma or unusual effort which conceivably could have injured the patient 's spleen ; there was no evidence of systemic or local disease in organs other than the spleen . moreover , there was no evidence of perisplenic adhesions or scarring that could have suggested trauma or previous rupture . aside from the hematoma , . the acute - phase and convalescent sera did not show any significant rise in viral antibody titers suggestive of recent infection with viral types associated with spleen involvement , such as epstein it usually is performed in conjunction with the intravenous administration of contrast material to maximize density differences between the splenic parenchyma and hematomas . in this fashion , ct is the imaging modality of choice as it allows for the best evaluation of the spleen and surrounding tissue changes . when a mass lesion is identified within the spleen on ct scan , ultrasound , or mri and the radiological diagnosis is inconclusive , splenectomy may be necessary as a combined diagnostic and curative procedure . in such cases , the conservative nonsurgical approach generally used in stable traumatic splenic injuries   is not adequate . in the past decade , laparoscopy has become the standard approach for elective splenectomy , even for patients such as ours , presenting with massive splenomegaly and hematoma . perioperative vaccination of patients undergoing splenectomy is crucial for protection against sepsis caused by encapsulated microorganisms including streptococcus pneumonia , hemophilus influenza and nisseria meningitides . vaccine administration should be carried out 2 weeks prior to elective cases and on average 2 weeks after unplanned splenectomies . therefore , idioapathic splenic hematomas are rare , and their diagnosis is challenging in the absence of a history of systemic disease or trauma or alarming signs such as hemorrhage or rupture on presentation . when thorough history taking and physical examination coupled with diagnostic imaging and laboratory work - up are inconclusive , a laparoscopic splenectomy is the ultimate diagnostic and curative approach .
spontaneous idiopathic splenic hematomas occur very rare . 
 hematomas of the spleen are usually associated with trauma , or infectious , neoplastic , or hematologic diseases . 
 they present a diagnostic challenge as they can be easily confused with other more common entities . 
 we report a case of atraumatic idiopathic splenic hematoma in a patient with no underlying systemic or local disease and discuss the approach to diagnosis and treatment .