Splenic Pregnancy: A New Minimally Invasive Approach to Treatment

Abstract

The spleen is a rare site of abdominal ectopic pregnancy. In a review of the literature, we found 16 published cases of primary splenic pregnancies. Of the cases identified, all received surgical intervention, with one case successfully treated with laparoscopic methotrexate injection, and the rest underwent splenectomy. We would like to present a case of primary splenic pregnancy in a 35-year-old woman successfully treated with percutaneous image-guided injection of methotrexate and KCl.

Management of splenic ectopic pregnancy presenting with massive haemoperitoneum

“…In the case of haemodynamic stability, abdominal ultrasound and CT imaging can be obtained prior to operative treatment 1 3 6. While previous authors have not previously employed MRI to aid in diagnosis, this modality may be considered in order to avoid radiation exposure 6. If a patient is haemodynamically unstable or has massive haemoperitoneum, as in the case of our patient, emergent surgical exploration is indicated to identify and address the source of active haemorrhage.…”

“…Primary abdominal pregnancy is defined according to criteria published by Studdiford in 1942: (1) normal fallopian tubes and ovaries with no signs of trauma, (2) no evidence of uteroperitoneal fistula and (3) the pregnancy is <12 weeks gestation and involves the peritoneal surface only 3 9. Primary splenic pregnancy is especially rare, with only 16 cases previously published 6. The average maternal age for splenic pregnancy is 28.7 years, with a gestational age of 7 weeks (range 4–9 weeks), demonstrating a significantly earlier presentation than other types of abdominal EP 3 8 10…”

“…The decision to obtain further diagnostic studies should depend on the clinical status of the patient. In the case of haemodynamic stability, abdominal ultrasound and CT imaging can be obtained prior to operative treatment 1 3 6. While previous authors have not previously employed MRI to aid in diagnosis, this modality may be considered in order to avoid radiation exposure 6.…”

“…Primary splenic pregnancy is the rarest form of EP abdominally and overall, with only 16 cases previously reported in the literature1 6 The spleen and liver provide especially favourable implantation sites because of their flat surfaces, readily accessible in the peritoneal cavity and extensive vascularity. However, since the placenta cannot attach and develop normally in these solid organs, splenic or hepatic capsular rupture can result, leading to haemorrhage 7.…”

Ectopic Gestation in Spleen: A Rare Case Presentation

“…Primary splenic pregnancy is the least common site of extrauterine gestation with only 16 cases described until date. [3] Here, we report a case of a 19 year old primigravida who came with complaints of pain in abdomen since 3-4 days with positive urine pregnancy test (UPT). Her ultrasonography (USG) was suggestive of moderate to severe hemoperitoneum with normal bilateral fallopian tubes and ovary and no evidence of intrauterine gestational sac.…”