Splenic rupture is an extremely rare but fatal complication in pregnancy.
A previously healthy 21 year old multigravida with a viable 8-weeks intrauterine gestation presented to the Ipswich Emergency Department with 2-day history of worsening left hypogastric pain and feeling unwell. There was no history of traumatic injury to abdomen. On arrival, she was hypotensive with BP 88/50 and was locally peritonitic over the left hypogastrium and suprapubic region. A formal ultrasound demonstrated a splenomegaly, moderate free fluid in the upper abdomen and pelvis. A lab test revealed a significant drop of 40g/L in her haemoglobin level from the day prior. A decision for emergency laparotomy was made after consultation with the general surgeons. Intraoperatively, a 2.8 litre haemoperitoneum and an enlarged spleen were identified. A grade 5 splenic parenchyma rupture secondary to a 720 degree volvulus of splenic vessels was discovered and a splenectomy was performed. The patient was subsequently admitted to the Intensive Care Unit for 4 days for inotropic support. She received a total of 6 units blood transfusion and 4 units of fresh frozen plasma perioperatively and was put on prophylactic intravenous broad spectrum antibiotics. She made an uneventful recovery and was discharged back to the community a week later. Histology of the spleen did not reveal any evidence of malignancy or infective lesions. At follow up, patient reported having terminated the pregnancy.
The mortality associated with splenic rupture in pregnancy is as high as 26% (Denehy et al, 1988). This is likely a result of delay in diagnosis and the rapid development of haemorrhagic shock in splenic rupture. Management is by emergency exploratory laparotomy and splenectomy. We recommend that splenic torsion and/or rupture should be considered when a pregnant patient presents in shock with an acute abdomen.