title: A case of simultaneous tubal-splenic pregnancy after assisted reproductive technology.
abstract: OBJECTIVE
  To present a case of simultaneous splenic and tubal pregnancy following in vitro fertilization.
  
  
  METHODS
  Case report.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  A 37-year-old woman who had undergone in vitro fertilization and embryo transfer for unexplained infertility at another clinic.
  
  
  METHODS
  Laparoscopy and laparotomy.
  
  
  METHODS
  Serum concentration of human chorionic gonadotropin (hCG) after salpingosplenectomy.
  
  
  RESULTS
  After transfer of three embryos following fertilization by intracytoplasmic sperm injection (ICSI) at another clinic, the patient was referred to our hospital with suspicion of ectopic pregnancy. Because tubal pregnancy was suspected, laparoscopic right salpingectomy was performed. Although villi were detected in the resected fallopian tube, the serum hCG concentration did not decrease after the operation and a new intraabdominal hemorrhage was detected. We then suspected abdominal pregnancy in the epigastric region, and performed magnetic resonance imaging, computed tomography, and ultrasound examinations, which revealed implantation at the inferior pole of the spleen. Splenectomy was performed, with the resulting disappearance of intraabdominal hemorrhage and rapid fall of the serum concentration of hCG.
  
  
  CONCLUSIONS
  Assisted reproduction sometimes results in heterotopic pregnancy, but an abdominal pregnancy involving the upper abdominal organs is considered extremely rare. Particularly, splenic pregnancy is usually overlooked and may only be discovered after a sudden intraabdominal hemorrhage. If hemorrhaging is present in the abdominal cavity but pregnancy is not detected within the pelvis, it is advisable to examine patients using imaging techniques to detect any upper abdominal pregnancies.
authors.affiliation: Department of Obstetrics and Gynecology, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Mari
authors.initials: M
authors.lastname: Kitade
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Takeuchi
authors.forename: Iwaho
authors.initials: I
authors.lastname: Kikuchi
authors.forename: Hiroto
authors.initials: H
authors.lastname: Shimanuki
authors.forename: Jun
authors.initials: J
authors.lastname: Kumakiri
authors.forename: Katsuyuki
authors.initials: K
authors.lastname: Kinoshita
mesh_terms: D000328:Adult; D006063:Chorionic Gonadotropin / Q000097:blood; D015897:Comorbidity; D005187:Fallopian Tubes / Q000601:surgery; D005260:Female; D005307:Fertilization in Vitro / Q000009:adverse effects*; D006801:Humans; D007231:Infant, Newborn; D007247:Infertility, Female / Q000628:therapy*; D010535:Laparoscopy; D007813:Laparotomy; D011247:Pregnancy; D011269:Pregnancy, Abdominal / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D011272:Pregnancy, Multiple; D011274:Pregnancy, Tubal / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D013154:Spleen / Q000000981:diagnostic imaging / Q000601:surgery; D013156:Splenectomy; D014057:Tomography, X-Ray Computed
chemical_list: D006063:Chorionic Gonadotropin