Splenic ectopic pregnancy: Rare location of ectopic pregnancy, how does it present?

Abstract

Splenic ectopic pregnancy (SEP) is a rare high-mortality condition, particularly relating to life-threatening intraperitoneal bleeding due to a high risk of spontaneous rupture. Diagnosing in a timely fashion is extremely crucial and the patients could benefit from active treatment strategies and early management. In this article, we reviewed a case of 40 years-old female who complained of lower quadrant abdominal pain and amenorrhea with a history of intrauterine device (IUD) insertion for over 6 years. Elevating b-human chorionic gonadotropin (HCG) blood levels were documented, raising concern about pregnancy-related emergency conditions. Ultrasound and magnetic resonance imaging results suggested a splenic ectopic pregnancy entity with a high rupture rate. The patient subsequently underwent laparoscopic resection for splenic mass removal. Ectopic pregnancy should cautiously be excluded in all cases of abdominal pain in childbearing-age women.

Keywords: Ectopic pregnancy; Intrauterine device; Splenic ectopic pregnancy.

Fig. 1

(A) Transvaginal ultrasound showed thick echogenic endometrium (14 mm) (dash arrow) with IUD (yellow arrow), no evidence of intrauterine gestational sac, free pelvic fluid, or hemoperitoneum was found. (B, C, D) Ectopic pregnancy in the spleen (B, dash arrows) with the extra-uterine fetal cardiac activity is 145 bpm (C), The diameter of the gestational sac is 11 mm equivalent to 6 weeks 4 days pregnancy (D).

Fig. 2

T2W axial plane (A), sagittal plane (B), and coronal plane (C) showed a heterogeneous signal intensity mass in the superior pole of the spleen (white arrow in image A and white dash circles in B and C). Out-phase (D) and in-phase (E) images did not show a dropped signal (white arrows). Moreover, subcapsular hematoma showed hyper-signal on T1W (F, white arrows).

Fig. 3

(A, B) Macroscopic image: Total resection of splenic ectopic pregnancy mass (A, B – white dash circles) and a part of superior pole spleen parenchyma (B, yellow stars). (C, D) Microscopic images showed chorionic villi of the placenta (C, D - red stars) inserted into the splenic parenchyma (D, dash blue circle).