Spontaneous splenic rupture associated with Rh incompatibility

Abstract

The following reports a case of spontaneous splenic rupture associated with Rh haemolytic disease in the newborn. Splenic rupture is very rarely encountered in neonatal practice and there are few previously reported cases associated with Rh incompatibility. It may be catastrophic if not recognised and given the often subtle signs in the initial stages, is difficult to diagnose. This report describes a term female infant born to a Rh negative mother with rising antibody titres. She received phototherapy shortly after delivery, was managed conservatively and remained stable until day 7 when she unexpectedly collapsed. Post mortem examination revealed splenic rupture with significant intra-peritoneal haemorrhage. Several etiologies have been proposed namely in utero trauma and birth trauma. A pathologically enlarged spleen, usually due to erythroblastosis fetalis, is known to be more liable to rupture. Rapid and accurate diagnosis is important for early surgical intervention, although supportive treatments allowing spontaneous cessation of the haemorrhage have been reported. In the case of splenic laceration, the time lag may be longer and a high index of suspicion is important. In the event of an otherwise unexplainable drop in haemoglobin it would be wise to consider an intra-abdominal pathology; ultrasonography and Computed tomography are considered the preferred methods of imaging.