Spontaneous Rupture of the Spleen: A Rare but Serious Case of Acute Abdominal Pain in Pregnancy

• Published in: The Journal of emergency medicine 2011-11, Vol.41 (5), p.503-506
• Main Authors: Wang, Chenhong, Tu, Xinzhi, Li, Shengli, Luo, Guoyang, Norwitz, Errol R
• Format: Article
• Language: English
• Subjects: abdomen; Abdominal Pain - diagnosis; Acute Disease; acute pain; Adult; Emergency; Female; Humans; Pregnancy; Pregnancy Complications - diagnosis; rupture; Rupture, Spontaneous - diagnosis; Shock, Hemorrhagic - etiology; spleen; Splenic Rupture - diagnosis; Stillbirth
• ISSN: 0736-4679; 2352-5029
• DOI: 10.1016/j.jemermed.2010.05.075

Abstract Background Spontaneous (non-traumatic) rupture of the spleen rarely occurs in the setting of a normal spleen, especially during pregnancy. Objectives We report a case of spontaneous rupture of a normal spleen at 33.7 weeks gestation and review the literature with the aim of exploring the etiology, diagnosis, and management of this condition during pregnancy. Case Report A 30-year-old Chinese primigravida presented at 33.7 weeks gestation with acute onset of severe, constant left upper abdominal pain. She developed acute hypotension. Physical examination revealed diffuse abdominal tenderness with rebounding and guarding. An emergent cesarean delivery and abdominal exploration was performed. A non-viable male infant was delivered, and active bleeding was identified at the splenic hilum consistent with splenic rupture. A splenectomy was performed, and a consumptive coagulopathy was identified and treated. The patient had an uncomplicated postoperative course and was discharged home on postoperative day 15. Conclusion Splenic rupture in pregnancy is a life-threatening complication. Early diagnosis and aggressive surgical intervention will allow for optimal maternal and perinatal outcome.