Spontaneous Rupture of Spleen in a Pregnant Armenian Woman with Favourable Pregnancy Outcome: Case Report

Norayr Ghukasyan

doi:10.4236/ojog.2021.112016

Abstract

Background: Spontaneous or traumatic rupture of spleen in pregnancy is a rare event with catastrophic consequences. This report presents a case of spontaneous splenic rupture of a pregnant woman with thrombophilia in complicated somatic history and successful cesarean section with maternal and infant survival. Case: A 28-year-old Armenian woman at 35 weeks of gestation presented to the Emergency Department at “Erebouni” medical center in Yerevan, Armenia with sharp pain in the epigastric region, general weakness and worsening condition. The patient was immediately transferred to the operating room. All clinical-laboratory examinations were urgently carried out, the fetus condition began to be assessed under the control of the CT. She was in obvious distress with blood pressure of 90/50 mm Hg and a pulse rate of 80 - 70 beats per minute. Abdominal ultrasound confirmed free fluid in the peritoneal cavity. Cesarean section was performed on the lower segment of the uterus. A live premature female infant was born weighing 2580 g, height 48 cm, and with an Apgar score of 7 - 8 points. Then the integrity of the uterus was restored. Abdominal rehabilitation was performed, there were about 1000 ml of blood loss and continuous internal bleeding. Doctors found splenic ruptures around the perineum. Lower middle laparotomy, splenectomy, abdominal rehabilitation, drainage were performed. Conclusion: This case illustrates the need to consider ruptured spleen as part of differential diagnosis of hemoperitoneum in pregnant women. Immediate surgical intervention is needed to ensure survival of mother and fetus.

Highlights

Splenic rupture is a potentially life-threatening complication usually occurring after blunt abdominal trauma or systemic disease
We present a case of spontaneous rupture in a pregnant woman with thrombophilia in complicated somatic history and successful cesarean section
Spontaneous rupture of spleen rarely occurs in the setting of a normal spleen during pregnancy

Summary

Introduction

Splenic rupture is a potentially life-threatening complication usually occurring after blunt abdominal trauma or systemic disease (infectious mononucleosis, malaria, hematologic abnormalities, etc.). Spontaneous rupture of spleen without prior trauma or systemic disease occurs rare and the correct diagnosis is rarely done before surgery. The rate of fetal death may approach 60% whereas maternal deaths may occur in about 10% of cases [1]. Traumatic splenic rupture in pregnancy or postpartum is a rare and frequently misdiagnosed event. It may be as a result of trauma or from preexisting pathology of spleen. We present a case of spontaneous rupture in a pregnant woman with thrombophilia in complicated somatic history and successful cesarean section. The peer-reviewed scientific literature studied by us [1]-[14] describes isolated cases of spontaneous rupture of spleen in pregnant women. In connection with the above, our observation may be of some interest

Case Presentation

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