Objective：To discuss the diagnosis and treatment of rupture of spleen in a baselevel hospital with limited conditions. Methods：The clinical data, diagnosis of bleeding by ultrasound, and results of nonoperative and operative treatment of 317 patients with rupture of spleen in Vila Central Hospital of the Republic of Vanuatu were retrospectively analyzed. Results：Ultrasound diagnosed 30 patients with subcapsular hemorrhage and 287 patients with true rupture of spleen. Based on ultrasound results, conservative treatment was used for 29 patients and 288 patients underwent operation. Conclusions：Ultrasonography had a high positive diagnostic rate for rupture of spleen, and the diagnosis of bleeding volume was consistent with the findings at operation. The findings on ultrasonography can be considered in selection of cases with appropriate indications for splenectomy. Ultrasonography is an effective method for use in the treatment of rupture of spleen.