Background: We report a case of spontaneous splenic rupture in a 27-year-old man with a known history of SS homozygous sickle cell disease. Case Report: The patient presented for increasing left basithoracic pain evolving for 4 days of spontaneous onset and signs of hypovolemia. The CT scan showed an intra-peritoneal effusion, an enlarged and heterogenous spleen, associated with perisplenic subcapsular hematoma, without parenchymal lacerations or active bleeding.  The diagnosis of spontaneous spleen rupture in the context of homozygous SS sickle cell anemia was finally retained and we decided to monitor the patient in intensive care unit without surgery. No complication occurred during the patient’s stay and he left the hospital three weeks after admission. Conclusion: Conservative treatment is a multidisciplinary decision that will require close monitoring in intensive care unit.