Emergency partial splenectomy for splenic ectopic pregnancy: A rare case report

Introduction and importance

Ectopic pregnancy can occur in many locations such as the fallopian tube, cervical, ovary or the abdomen. Splenic ectopic pregnancy (SEP) which is rarely reported in the literature, is a very dangerous condition because the spleen capsule is very thin and the spleen parenchyma is rich in blood vessels.

Presentation of case

A 40-year-old woman, gravida 2, Para 2, had not menstruated for 37 days, presented in the emergency department with a chief complaint of vaginal bleeding and mild hypogastric pain for 1 week. Her serum Beta-human gonadotropin (β-HCG) level was 34279 IU/L. Abdominal ultrasound demonstrated a homogeneous echogenic structure in the upper pole parenchyma of the spleen, measuring 46 × 48 mm in diameter, containing the gestational sac and embryonal heart rate. Magnetic resonance imaging revealed a mass located in the upper pole of the spleen. Partial splenectomy was successfully and safely performed.

Clinical discussion

Surgical treatment of SEP is indicated for symptomatic or having a fetal heart rate or an elevated β-HCG level >30000 IU/L. The surgical methods are total splenectomy, laparoscopically injecting Methotrexate. This is the first case of partial splenectomy in the treatment of SEP.

Conclusion

Diagnosis of splenic ectopic pregnancy is mainly based on clinical and abdominal ultrasound. MRI may be indicated in cases when the patient arrives early and helps to identify the location of the lesion. Partial splenectomy is indicated when the ectopic pregnancy mass is located at one splenic pole.