Spontaneous splenic rupture in pregnancy is rare and occurs most commonly in third trimester or puerperium1. Several case reports have been published since the first case report in 1803 2. This entity is of great importance since it carries a very high rate of maternal and fetal mortality if the possibility is not suspected. We present a rare case of spontaneous rupture of spleen in third trimester of pregnancy, the only one seen over last 10 years in our institution.
A 27 years old G3P1L1A1 was admitted at 8 months amenorrhea with complaints of sudden onset of acute abdominal pain. Pain was associated with nausea, vomiting and syncopal attacks. It was also referred to the left shoulder tip. There was no preceding history of trauma or vaginal bleeding. She had reported to a level II hospital in a state of shock where she was resuscitated and was referred to our tertiary care teaching institution as a case of abruptio placenta.
On general physical examination she was anxious but well oriented. Pallor was moderate with mild circulatory decompensation (pulse rate of 120 per minute and blood pressure of 110/80 of mmHg). On abdominal examination the uterus was of 30 weeks size and fetal heart sounds were clearly heard. There was tenderness all over the abdomen with maximum intensity in left lumbar region. Clinical evidence of free fluid was present. On vaginal examination the os was closed and no vaginal bleeding was noted. Obstetric sonography revealed a single live fetus of 30 weeks gestation with large amount of free fluid in the abdomen. Abdominal paracentesis revealed hemoperitoneum. Emergency laparotomy was done and approximately 3 L of fresh and clotted blood was removed. Source of bleeding was found to be approximately 3x3 cm defect in splenic capsule with active bleeding from the ruptured site. Splenectomy was done by a surgical colleague. The uterus was found to be intact. Liver was palpated and found to be normal. The patient received 4 units of blood transfusion during surgery. Postoperative period was uneventful. Patient received intramuscularly injection proluton depot and two doses of injection decadron 12mg, 12 hours apart along with antibiotics.
Keywords : spontaneous splenic rupture, pregnancy,hemoperitoneum
Spontaneous splenic rupture in pregnancy is rare and occurs most commonly in third trimester or puerperium1 . Several case reports have been published since the first case report in 1803 2. This entity is of great importance since it carries a very high rate of maternal and fetal mortality if the possibility is not suspected. We present a rare case of spontaneous rupture of spleen in third trimester of pregnancy, the only one seen over last 10 years in our institution.
A 27 years old G3P1L1 A1 was admitted at 8 months amenorrhea with level. After 2 cycles of chemotherapy given with an interval of 3 weeks, α-fetoprotein level came down to 1.06ng/mL. On 21st November, 2003 further chemotherapy was denied by the patient due to financial problem. On the 14th July, 2004, she came to the outpatient with acute pain and lump in the abdomen.
The tumor recurrence necessitated a laparotomy at which a large intraperitonial, friable, hemorrhagic mass adherent to the parietes and the surrounding omentum was found in the left hypochondrium. The uterus and left sided tube and ovary were unremarkable. There was no ascitis.The mass was removed
Histopathology of the excised mass showed deposits of yolk sac tumor in the peritoneum with large areas of hemorrhage and necrosis. Serum αfetoprotein level was high. X-ray chest and sonography of the whole abdomen gave normal findings. Chemotherapy was started again but she expired on 20th August, 2004.
Endodermal sinus tumor of the ovary is a neoplasm of young adults. The serum α-fetoprotein level is invariably high. Clinical stage is the most important prognostic factor. Serial estimation of serum α-fetoprotein is useful in monitoring the tumor course1.
Association of endodermal sinus tumor of the ovary with pregnancy is a rare event. Review of the literature revealed that combination chemotherapy during pregnancy had a successful outcome for mother and fetus2 . Tumor reductive surgery strongly affects the prognosis3 .
Unfortunately our patient came in labor and delivered a preterm fetus
before the diagnosis of ovarian tumor was made.
