Near-fatal spontaneous hepatic rupture in a young healthy individual: a case report of successful non-surgical management and literature review

Introduction and importance: Spontaneous hepatic rupture (SHR) is a rare but potentially fatal event, usually associated with liver tumors, pregnancy-related complications, or connective tissue disorders. Idiopathic SHR in healthy individuals is extremely rare. Case Presentation: A 19-year-old man with no history of trauma or underlying disease presented with acute epigastric pain and vomiting. The patient developed shock a few hours following admission and was shifted to the ICU. Imaging revealed a large subcapsular hepatic hematoma and hemoperitoneum. The patient was hemodynamically stabilized and managed conservatively with transfusions, antibiotics, analgesics, and close monitoring. Follow-up imaging showed gradual resolution of the hematoma. The patient remained stable during outpatient follow-up. Clinical discussion: Early diagnosis plays a crucial role, especially in cases of atraumatic hemoperitoneum. Even in the presence of shock, one should avoid rushing into surgical intervention. Initial aggressive resuscitation with blood and blood products may stabilize the patient and potentially obviate the need for major surgical procedures such as hepatectomy, as observed in this case. Conclusion: Idiopathic SHR, though rare, should be considered in atraumatic hemoperitoneum. This case is a unique example of idiopathic SHR in a young, healthy man managed entirely without surgical intervention.