title: Management of splenic ectopic pregnancy presenting with massive haemoperitoneum.
abstract: Abdominal ectopic pregnancy (EP) accounts for only 1.3% of EPs and occurs when a fertilised ovum implants in an extrapelvic peritoneal location. Primary splenic pregnancy is a rare type of abdominal EP, with only 16 cases previously reported in the literature. Early diagnosis is essential as delay in treatment carries significant potential for morbidity and mortality. We present the case of a 27-year-old woman presenting with left upper quadrant abdominal pain, elevated human chorionic gonadotropin levels, absence of intrauterine gestational sac and massive haemoperitoneum on transvaginal ultrasound. The patient underwent emergent surgical exploration for high suspicion of ruptured abdominal EP. An open splenectomy was performed when the source of bleeding was confirmed to originate from the left upper quadrant. Final pathology confirmed subcapsular gestational sac implantation within the spleen. While two cases of medical management have been reported, splenectomy remains the current definitive management of rare cases of primary splenic pregnancy.
authors.affiliation: Department of Surgery, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA.
authors.forename: Alissa
authors.initials: A
authors.lastname: Greenbaum
authors.affiliation: Department of Surgery, University of New Mexico, Albuquerque, New Mexico, USA.
authors.forename: Richard
authors.identifier: http://orcid.org/0000-0001-7108-3542
authors.initials: R
authors.lastname: Miskimins
authors.affiliation: Department of Pathology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA.
authors.forename: Brittany
authors.initials: B
authors.lastname: Coffman
authors.affiliation: Department of Surgery, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA.
authors.forename: Jasmeet
authors.initials: J
authors.lastname: Paul
mesh_terms: D000328:Adult; D019468:Disease Management; D019160:Endosonography; D005260:Female; D006465:Hemoperitoneum / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D006801:Humans; D011247:Pregnancy; D011269:Pregnancy, Abdominal / Q000175:diagnosis / Q000601:surgery*; D013154:Spleen; D013156:Splenectomy / Q000379:methods*; D016216:Ultrasonography, Prenatal; D014621:Vagina