Primary Splenic Pregnancy- A Rare but Imperative Cause of Hemoperitoneum - Case Report and Review of Literature.

Ruchi Rathore,Ratna Chopra,Namrata Nargotra,Shilpi Shilpi

doi:10.5146/tjpath.2017.01403

Abstract

Primary splenic pregnancy is an extremely rare form of extratubal ectopic pregnancy. These cases often cause splenic rupture in very early course of their gestation thereby presenting with hemoperitoneum in emergencies. Owing to the higher risk of exsanguination and death caused by hemoperitoneum, it is essential to diagnose these cases for proper management and better prognosis of the patients. We present the case of a 23-year-old female, gravida 2, para 1, live issue 1 presenting to the emergency outpatient department with acute abdomen and hemoperitoneum. There was no history of trauma. The patient had a positive urine pregnancy test and raised beta HCG levels. Emergency laparotomy revealed an otherwise unremarkable fallopian tube and ovary with a hemoperitoneum of 2.5 liters. A tiny splenic laceration was considered to be the source of bleeding and splenectomy was performed. Microscopy was suggestive of a primary ectopic pregnancy, spleen. Since hemoperitoneum in pregnancy is a rare but potentially fatal condition with a high risk of mortality, an accurate preoperative diagnosis is crucial in the management of such patients. The possibility of a ruptured extratubal ectopic pregnancy must be considered as one of the differential diagnoses of acute abdomen with hemoperitoneum in women of childbearing age.

Highlights

The implantation of a fertilized ovum anywhere outside the uterine cavity is known as ectopic pregnancy
Since ruptured ectopic pregnancy is a well recognized life-threatening entity in early pregnancy and is one of the known causes of hemoperitoneum in pregnancy, we present an unusual case of primary splenic pregnancy presenting as acute abdomen with hemoperitoneum being misinterpreted as splenic laceration following blunt trauma to the abdomen in the emergency setting
Multiple sections were taken from the spleen and examined histopathologically

Summary

INTRODUCTION

The implantation of a fertilized ovum anywhere outside the uterine cavity is known as ectopic pregnancy. The obstetric history revealed that the patient had given birth by normal vaginal delivery one year back followed by a medical termination of pregnancy 3 months back in November. Her last menstrual period was due in December at the time of presentation at the emergency and she currently had amenorrhea for 4 weeks and 2 days. Based on the above findings, a presumptive diagnosis of ruptured ectopic pregnancy was made and the patient was referred to the gynecology department She underwent emergency laparotomy for the same. She was given 3 units of blood transfusion postoperatively and was thereby stabilized there after

Pathological Findings

DISCUSSION

13 Current study