<p>A 63-year-old female underwent video-assisted thoracoscopic surgery (VATS) for pleural decortication due to recurrent pneumothorax four months after left lung surgery. The patient experienced hemodynamic instability during repositioning from lateral to supine post-procedure. No injury to the diaphragm or chest wall was identified during the procedure and no source of bleeding was identified intraoperatively. The patient was transferred to the ICU. A bedside ultrasound revealed a large amount of free fluid in the abdomen. Diagnostic paracentesis yielded non-clotting blood, suggestive of intra-abdominal hemorrhage. An emergency exploratory laparotomy was performed, revealing a splenic rupture, necessitating splenectomy. The patient’s hemodynamics stabilized postoperatively, and she was extubated the following day. She was discharged in stable condition 28 days later.</p>