Sixty-three cases of traumatic rupture of the spleen were analyzed. The patients were admitted to our hospitals during the last 24 years and there has been a steady increase in the numbers seen. The great majority of these cases resulted from road traffic accidents, and 33% of the patients had multiple injuries. Most were in the second and fourth decades; males outnumbered females by nearly four to one. Associated injuries, which occurred in 33% of cases, significantly raised the mortality. The mortality was also higher in the older age group and in those patients who had multiple injuries and were severely shocked on admission. Difficulty and delay in diagnosis occurred particularly in the unconscious patients and also in those in whom shock was not apparent, particularly when abdominal signs were late in developing. Treatment by resuscitation and splenectomy was used routinely and our overall mortality was 17.5%. Complications were frequent, the most serious being gastrointestinal and respiratory. A long-term follow-up showed that the great majority of patients have done well. There has been no evidence of an increased infection risk following splenectomy, and all but a few patients were able to return to their former sporting activities.