A splenic injury, which includes a ruptured spleen, is any injury to the spleen. The rupture of a normal spleen can be caused by trauma, such as a traffic collision.

In minor injuries with little bleeding, there may be abdominal pain, tenderness in the epigastrium and pain in the left flank. Often there is a sharp pain in the left shoulder, known as Kehr's sign. In larger injuries with more extensive bleeding, signs of hypovolemic shock are most prominent. This might include a rapid pulse, low blood pressure, rapid breathing, and paleness.

The most common cause of a ruptured spleen is blunt abdominal trauma, such as in traffic collisions or sports accidents. Direct, penetrating injuries, for example, stab or gunshot wounds are rare.^{[citation needed]}

Non-traumatic causes are less common. These include infectious diseases, medical procedures such as colonoscopy, haematological diseases, medications, and pregnancy.

In less than one percent of cases of infectious mononucleosis splenic rupture may occur.

Splenic rupture is usually evaluated by FAST ultrasound of the abdomen. Generally this is not specific to splenic injury; however, it is useful to determine the presence of free floating blood in the peritoneum. A diagnostic peritoneal lavage, while not ideal, may be used to evaluate the presence of internal bleeding a person who is hemodynamically unstable. The FAST exam typically serves to evaluate the need to perform a CT scan. Computed tomography with IV contrast is the preferred imaging study as it can provide high quality images of the full peritoneal cavity.

AAST (American Association for the Surgery of Trauma) Organ Injury Scaling: Splenic Injury Grading

Calculators have been developed that facilitate grading of splenic injury based on imaging findings.