Intra-abdominal complications of infective endocarditis have decreased in frequency during the antibiotic era.1 Infarction of the spleen remains one of the most common causes of abdominal pain in patients with bacterial endocarditis. On occasion, this may lead to splenic rupture, hemorrhagic peritonitis, vascular collapse, and death. If recognition and treatment of splenic rupture are prompt, a benign clinical course is likely to follow, while if it is untreated, the outcome is usually fatal. Successful splenectomy in a patient with a ruptured spleen and bacterial endocarditis prompted the report of this case.
A 61-year-old male laborer, who was a chronic alcoholic, first noted fatigue and malaise in the fall of 1973. In October 1973, the hemoglobin value was 8.8 gm/100 ml of blood, but no therapy was given. On Nov 20, bright red blood appeared in the sputum, along with dyspnea, chills, and fever. He was treated with