Spontaneous rupture of the spleen: a rare but serious case of acute abdominal pain in pregnancy. J Emerg Med. 2011;41:503-506. [PMID: 20813482 DOI: 10.1016/j.jemermed.2010.05.075]

A Splenic Rupture Following a Singleton Spontaneous Vaginal Delivery: The First-Known Case Report in Saudi Arabia

A spontaneous rupture of the spleen during pregnancy or post-delivery is an exceptionally rare but potentially fatal maternal complication that poses a significant challenge in diagnosis and management. Herewith, we present a case of a 31-year-old female patient who experienced a spontaneous splenic rupture following a singleton vaginal delivery. Despite lacking any history of trauma or a predisposing factor, she developed symptoms of dizziness and postpartum abdominal pain, progressing rapidly to unconsciousness. Urgent abdominal ultrasound revealed significant intraperitoneal bleeding with a large peri-splenic hematoma, necessitating emergency exploratory laparotomy. Histopathological examination of a frozen section ruled out malignancy, and thus, a complete splenectomy was done, which confirmed the diagnosis of spontaneous splenic rupture. This case emphasizes the importance of close monitoring of all postpartum women, even those with low-risk pregnancies, for the early detection of any complication. Healthcare providers should maintain a high index of suspicion for rare but potentially life-threatening events to ensure timely intervention and optimal outcomes.

Pregnancy With Massive Splenomegaly and Pancytopenia: A Case Report

Massive splenomegaly complicating pregnancy is a rare clinical entity that poses special difficulties, such as anemia, thrombocytopenia, ascites, and jaundice. This case report of a pregnant woman with large splenomegaly and pancytopenia highlights the value of prompt diagnosis and effective treatment. Splenomegaly can have a number of causes, including viral infections, hematological problems, portal hypertension, and metabolic abnormalities. A 29-year-old gravida 3 woman at 37 weeks of gestation who had massive splenomegaly was admitted and underwent a cesarean section to avoid complications of splenomegaly. The case report discusses the difficulties in obstetric management caused by enormous splenomegaly during pregnancy, including the choice of delivery method. Significant complications include splenic rupture and bleeding, particularly when pancytopenia is present. The need for several transfusions, the potential side effects of transfusion therapy, and factors related to the origin of splenomegaly when assessing maternal-fetal outcomes are discussed in this case report. The study concludes that in cases with pancytopenia splenomegaly during pregnancy, vigilant monitoring, prompt intervention, and a multidisciplinary approach are crucial to achieve positive outcomes for both the mother and the fetus.

Spontaneous Splenic Rupture Following Vaginal Delivery in Severe Preeclampsia: A Case Report

Spontaneous rupture of the spleen during pregnancy is a rare and life-threatening occurrence, typically occurring in the third trimester or postpartum period. The mechanisms behind this phenomenon are still not fully understood, as it can happen without any obvious trauma, and even a minor abdominal strain can trigger it. We present a case of a 25-year-old woman with severe preeclampsia in which vaginal delivery was followed by spontaneous splenic rupture. A splenectomy was performed. Early diagnosis and management are crucial and can be aided by physical examination, ultrasonography, and clinical suspicion. It is imperative for obstetricians to be aware of this potentially fatal condition, as delayed diagnosis and treatment can have serious consequences for both the mother and the neonate.

Intra-abdominal hemorrhage during pregnancy: Four case reports

BACKGROUND

Intra-abdominal hemorrhage during pregnancy is a rare and dangerous complication of pregnancy. In this article, we report 4 cases of intra-abdominal hemorrhage during pregnancy, including the spontaneous rupture of uterine veins, spontaneous rupture of liver, rupture of external iliac vessel branch, and rupture of right renal hamartoma.

CASE SUMMARY

The clinical manifestations of three patients lacked specificity, and the localization of the bleeding was not clear prior to surgery. All 4 pregnant women were successfully treated, while only one full-term infant survived.

CONCLUSION

There are diverse causes of intra-abdominal hemorrhage during pregnancy in clinic, and it is clinically characterized by acute abdominal pain during pregnancy. Clear diagnosis before surgery is rather difficult. Early diagnosis, timely and appropriate treatment and surgery, and multidisciplinary cooperation are key to saving pregnant females’ lives and improving the outcomes of perinatal infants.

Splenic Rupture and Postpartum Hemorrhage After Emergent Cesarean Delivery: A Case Report

Postpartum hemorrhage is a leading cause of maternal and fetal mortality. Although rare, peripartum splenic rupture (PSR) is a lethal cause of bleeding due to variable presentation and delayed diagnosis. A 22-year-old gravida 2, para 0, abortus 1 (G2P0A1) woman presented for premature rupture of membranes and was diagnosed with Influenza A and chorioamnionitis. She underwent emergent cesarean delivery under general anesthesia. Postoperatively, her condition worsened despite treatment for presumed sepsis. She was taken to the operating room for an exploratory laparotomy, and a splenectomy was performed for splenic rupture. We discuss management, risk factors, challenges, and importance of prompt treatment of PSR.

A Near Fatal Sneeze Spontaneous Splenic Rupture: A Case Report and Review of the Literature

A 79-year-old female called 911 for abdominal pain in her left upper quadrant with radiation through to her back and left shoulder for three hours. Upon arrival to the emergency department her physical exam was positive only for tenderness in the left upper quadrant of her abdomen. The patient denied any history of trauma but reported she “did sneeze three times” just prior to the onset of her pain. Computed tomography angiography of the abdomen and pelvis was obtained to evaluate for vascular pathology. The radiologist immediately called with concern for splenic laceration. The general surgeon took the patient directly to the operating room where she underwent a splenectomy and recovered without sequelae. This is the first case report of spontaneous splenic rupture that resulted after the act of sneezing. It is important to be aware of this rare clinical entity because early recognition can be life saving.

Littoral cell angioma with splenic rupture in pregnancy

Splenic rupture in pregnancy is a rare event. It is generally due to trauma or an underlying splenic pathology. Timely diagnosis and intervention of splenic rupture is essential given the high rates of associated maternal and fetal morbidity and mortality. This case illustrates a 38 year old lady in the third trimester of pregnancy who presented with maternal collapse and a non-reassuring foetal heart rate tracing following a fall at home one week previously. A massive hemoperitoneum was identified at caesarean section and a splenectomy was performed. Histological examination revealed a littoral cell angioma of the spleen. This vascular tumour arising in the splenic red pulp sinuses is a rare entity and specific immunophenotypic features help distinguish it from other vascular tumours of the spleen. Both trauma and an underlying splenic pathology led to splenic rupture in this unique case.

Acute appendiceal abscess and atraumatic splenic rupture: A case of dual pathology

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Acute appendicitis may co-present with atraumatic splenic rupture.

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Hypovolaemic shock secondary to splenic rupture may co-exist with septic shock.

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Complex presentations warrant careful consideration and swift management of dual pathologies.

Introduction

Atraumatic splenic rupture is a rare surgical emergency that is often attributed to neoplastic or infectious causes. Rarely, it has been identified to also occur in the setting of an acute severe sepsis and in cases of pelvic or splenic abscess formation post-appendicectomy. However, to our knowledge, the co-presentation of acute appendiceal abscess and splenic rupture has not been previously described.

Presentation of case

We present the case of a 67-year old male with decompensating haemorrhagic shock secondary to atraumatic splenic rupture on a background of an inadequately treated complicated appendicitis originally managed as diverticulitis with antibiotics in the community. Intra-operatively, in addition to a de-gloved, ruptured spleen; an acutely inflamed appendiceal abscess was also identified. A concomitant splenectomy, washout and appendicectomy and was therefore performed.

Histopathological examination revealed a normal spleen with a stripped capsular layer. Mucosal ulceration, transmural inflammation and serositis of the appendix appeared to be consistent with acute appendicitis.

Discussion

Our case demonstrates how inadequately treated sepsis may predispose to an acute presentation of splenic rupture with associated haemorrhagic shock; which may initially be interpreted as septic shock. However, we demonstrate how insults such as sepsis and haemorrhagic shock may co-exist warranting careful consideration of possible dual pathologies in complex presentations which may be life-threatening.

Conclusion

While the causal relationship between acute appendicitis and atraumatic spontaneous splenic rupture remains unclear, our case considers and highlights the importance of considering dual pathology in patients presenting in the acute setting.

Spontaneous splenic rupture in pregnancy

Splenic rupture during pregnancy is a rare and can frequently be a misdiagnosed pathology. This rupture is associated with a high maternal and fetal mortality rate. A 26 years old Moroccan woman para II gravida II presented at the third stage of pregnancy with acute onset of severe abdominal pain. She developed immediately a hypovolemic shock. After both a physical and sonographical exam, it was revealed that it was due to a massive hemoperitoneum. Therefore, an emergent laparotomy and cesarean delivery with abdominal exploration were performed; also, an active bleeding was identified at the splenic hilum consistent with splenic rupture. Through this case report, we want to raise awareness of this surgical emergency that requires immediate recognition because any delay can lead to catastrophic consequences

Autoimmunity, preeclampsia and splenic rupture: a case report and literature review

Antiphospholipid antibody (APLA) syndrome is an autoimmune disease which is associated with preeclampsia and can cause thromboembolic events in several organs including the spleen. This report includes a case of post-partum splenic rupture in a woman with preeclampsia in the presence of APLA syndrome and a literature review of splenic rupture during the third trimester and puerperium. Unlike the prominent clinical manifestation of liver hematoma and rupture during preeclampsia, rupture of the spleen can be silent and mistakenly underdiagnosed.

Misdiagnosed uterine rupture of an advanced cornual pregnancy

Cornual pregnancy is a diagnostic and therapeutic challenge with potential severe consequences if uterine rupture occurs with following massive intraabdominal bleeding. We report a case of a misdiagnosed ruptured cornual pregnancy occurring at 21 weeks of gestation. Ultrasound examination and computer tomography revealed no sign of abnormal pregnancy. The correct diagnosis was first made at emergency laparotomy. Uterine rupture should be considered in pregnant women presenting with abdominal pain and haemodynamic instability.