Conservatively managed spontaneous splenic rupture in pregnancy with severe preeclampsia: an interesting case report

Abstract

Spontaneous splenic rupture during pregnancy can be catastrophic with most of the cases needing splenectomy. We presence an interesting case of conservatively managed spontaneous splenic rupture in pregnancy. A 24-year-old G2P1L1 with 35 weeks gestation with previous LSCS severe preeclampsia and severe anaemia was referred from a peripheral centre. On examination, she was vitally stable with marked pallor and pedal oedema. Abdominal wall oedema and ascites was present, uterus was 28 weeks with FHS localised by Doppler. After 2 hours, patient complained of continuous pain abdomen. It was tense, tender with FHS non-localised, uterine fundus could not be made out. USG revealed a retroplacental hematoma of 3.5×2.2 cm with free fluid in the abdomen. Differential diagnosis of rupture uterus and abruptio placenta were made. Emergency laparotomy was done. Intraoperatively, 800 cc fresh hemoperitoneum was present, previous scar was intact and a live baby delivered by LSCS. Uterus, bilateral tubes and ovaries were normal. After the uterus was closed, fresh intraabdominal bleeding was still present. With the help of general surgeon, exploration was done and two long superficial splenic tears (grade 2 splenic injury) with continuous oozing were identified. Contact pressure was applied by gauze. Bleeding stopped and omental wrapping around spleen was done. Abdomen was closed after putting drain and patient was shifted to ICU for monitoring. After 27 days, patient was discharged in a stable condition. Thus, spontaneous splenic rupture should be considered in the diagnostic differential of hemodynamic instability in a case of severe preeclampsia. Emergency laparotomy before the setting of collapse and DIC are vital steps to save the spleen and improve feto-maternal survival.