Snapshot A 28-year-old man is brought to the ED following a motorcycle accident. The patient is unconscious and a trauma survey is remarkable for fractures of the 8th, 9th, and 10th ribs on the left side. The patient is hypotensive and has not been responsive to several liters of crystalloid fluids. A CT scan is shown. Introduction The spleen is the most common organ injury following trauma that results in significant intraabdominal bleeding liver injury is the most common cause of bleeding but is more often clinically insignificant Risk factors left-sided rib fractures history of blunt abdominal trauma EBV infection leading to splenomegaly Presentation Symptoms referred pain to left shoulder (Kehr sign) result of irritation of the diaphragm Physical exam hypotension shock Evaluation Imaging CT scan important in showing extent of splenic injury Exploratory laparotomy Treatment Surgical endovascular embolization indicated with incomplete rupture splenectomy indicated with complete rupture or intractable bleeding Prognosis, Prevention, and Complications Post-splenectomy immunization patients are at increased risk of encapsulated organism infections including S. pneumoniae, H. influenza, N. meningitidis (SHiN) Subphrenic abscess complication of splenectomy, acute pancreatitis, trauma, and other abdominal surgeries presents with elevated WBC's, fevers, pleuritic pain, and left shoulder pain (referred from phrenic nerve irritation) Hematologic findings - due to decreased splenic clearance thrombocytosis Howell-Jolly bodies