Hypovolemic shock and spontaneous splenic rupture (SSR) are unusual fatal complications in
the uraemic patients. We described a case of SSR in a 29-year-old hemodialysis (HD) patient. The
diagnosis was confirmed with the acute abdomen picture included the left upper abdominal and
left shoulder pain together with shock and ultrasound findings. The splenectomy was performed.
The postoperative course was uneventful and the patient was discharged from hospital on the 5th
day. The mechanism of the rupture is still unknown, but the rupture and subcapsular haematomas
of spleen may be induced by the uraemic coagulopathy, the use of anticoagulants during HD,
malignant hypertension and unrecognised microtrauma. Splenic rupture should be considered
in any patient with abdominal pain and shock, regardless of a history of trauma or previously
known risk factors for spontaneous rupture. An aggressive multidisciplinary approach to the
management of these patients may decrease the mortality rate.