Splenic pregnancy

Pan, Bing; Lyu, Shao-cheng; He, Qiang

doi:10.1016/j.medcli.2018.10.018

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The arrow is pointing to chorionic." ] ] ] "textoCompleto" => "Pregnancies occurring within the peritoneal cavity excluding the fallopian tube, ovaries and ligaments of the uterus are named abdominal pregnancy.<a class="elsevierStyleCrossRef" href="#bib0020">1</a> Abdominal pregnancy is a rare and high-risk complication that ultimately requires laparotomy. Its incidence ranges from 1/10,000 to 1/30,000.<a class="elsevierStyleCrossRef" href="#bib0025">2</a> Primary abdominal pregnancies, especially primary pregnancy in the spleen are very rare. We report the case of hemorrhagic shock caused by splenic pregnancy and rupture was successfully treated in our hospital. Details are reported as follows.A 27-year-old married female patient presented to the emergency department with sudden onset severe abdominal pain for 5hours. The patient felt weakness, dizzy, fainting, nausea, vertigo. Then vaginal was bleeding 1h ago. There was no history of any recent trauma to the chest and abdomen. At the time of admission, her last menstrual period was 47 days. On admission, her pulse rate (P) was 88/min and blood pressure 75/48mmHg. She was sane, had a pale complexion and ventral tubercle, and had whole abdominal tenderness combined with rebounding pain. Laboratory values on arrival were hemoglobin (Hb) 115g/L, prothrombin time (PT) 32s and activated partial thromboplastin time (APTT)>180s. The serum β-hCG was 2657mIU/mL (the threshold of positive results is 0.7mIU/mL). A urine β-hCG test was positive. The gynecological examination showed a normal cervix and no uterus or adnexa tenderness. Transvaginal sonography revealed a normal-size uterus with a thickened endometrium without individual gestational sac; the pelvic cavity had a medium volume of effusion. The provisional diagnosis was hemoperitoneum, hemorrhagic shock and ruptured ectopic pregnancy. As patient was deteriorating rapidly, the gynecologist carried out an exploratory abdominal laparoscopy. However, intraoperatively it was noted that there was 1500ml of blood and blood clots in the peritoneal cavity. The uterus and bilateral adnexa were unremarkable and the source of bleeding was from liver or spleen. Then the hepatobiliary surgeons were called in and found that there were active hemorrhage sites on the spleen. There was a small cyst approximately 2cm in size on the spleen. After making a diagnosis of splenic ectopic pregnancy, splenectomy was performed by the surgeons. The entire procedure lasted 390min. Histopathological examination revealed blood clots with chorionic villi and trophoblastic tissue within the splenic tissue, which was consistent with a splenic ectopic pregnancy (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The patient was discharged at 12 days after surgery.<elsevierMultimedia ident="fig0005"></elsevierMultimedia>Abdominal pregnancy refers to ectopic pregnancies in sites except the oviduct, ovary, and broad ligament.<a class="elsevierStyleCrossRef" href="#bib0030">3</a> The liver and the spleen are more favorable for implantation because they are flat organs, rich in blood flow, and easily reached by the fertilized ovum in the supine position.Once abdominal hemorrhage occurs, consultation involving gynecology, internal medicine, general surgery, and other departments is often required.<a class="elsevierStyleCrossRef" href="#bib0030">3</a> In nearly all cases of splenic pregnancy, an emergency operation had to be performed before diagnostic imaging because of severe intra-abdominal hemorrhage or acute abdomen. With the development of laparoscopic minimally invasive techniques, some patients with early detection or mild symptoms may prefer to undergo surgery under a laparoscope: the entire abdominal cavity must be evaluated, and removal of ectopic pregnancy could be attempted, especially in case of timely diagnosis. The final diagnosis of splenic ectopic pregnancy in our case was made only after histological examination.Abdominal pregnancy is rare but has high maternal mortality rates. Preventing abdominal pregnancy-related deaths depend, in part, on increasing awareness of its clinical characteristics; abdominal pregnancy should be considered in the differential diagnosis of acute abdomen in women of reproductive age. Basic clinical skills, such as a detailed inquiry of disease history, careful and complete physical examinations, and timely exploratory laparotomy, remain the key to the treatment for patients with this condition." 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Srivastava" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.5582/irdr.2015.01006" "Revista" => array:6 [ "tituloSerie" => "Intractable Rare Dis Res" "fecha" => "2015" "volumen" => "4" "paginaInicial" => "105" "paginaFinal" => "107" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25984430" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0030" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Case of spontaneous splenic rupture caused by ectopic pregnancy in the spleen" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "B.Q. Wu" 1 => "F. Zhu" 2 => "Y. Jiang" 3 => "D.L. Sun" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/jog.13440" "Revista" => array:6 [ "tituloSerie" => "J Obstet Gynaecol Res" "fecha" => "2017" "volumen" => "43" "paginaInicial" => "1778" "paginaFinal" => "1780" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28762583" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/00257753/0000015300000001/v1_201906160629/S0025775318306481/v1_201906160629/en/main.assets" "Apartado" => array:4 [ "identificador" => "66430" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Cartas al Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/00257753/0000015300000001/v1_201906160629/S0025775318306481/v1_201906160629/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775318306481?idApp=UINPBA00004N"]

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