Abstract: Background: Spontaneous splenic haematoma, in the absence of trauma is rare in young immunocompetent adult. Malignancy, infection, and medication are some of the aetiologies identified. Diagnosing spontaneous splenic haematoma is a challenge as it may mimic other disease. Case Presentation: A 21-year-old male presented to emergency district hospital with umbilical pain migrating to right iliac fossa. Physical examination revealed right iliac fossa tenderness but no peritonism. Provisional diagnosis of perforated appendicitis was made and patient was planned for open appendicectomy via Lanz incision. Reassessment revealed generalized abdominal pain and patient underwent lower midline laparotomy. Intraoperatively there was 1.8L of haemoperitoneum and haematoma was found at splenic hilum. Splenectomy was performed and patient was discharged well with prophylaxis antibiotic. Conclusion: Spontaneous splenic haematoma is rare and should be considered in young immunocompetent adult presenting with abdominal pain.