Hemorrhagic shock caused by primary splenic pregnancy with spontaneous splenic rupture

The subject, splenic pregnancy, is very rare and interesting with about a few cases reported to date. This case report describes a healthy 17-year-old girl admitted to our hospital who complained of amenorrhea for 30 days, intermittent abdominal pain for 3 days and worsening for 1 h. The serum human chorionic gonadotropin (hCG) was greater than 10000.0 IU/L. Pelvic ultrasonography showed a adnexal mass and empty uterine cavity. Due to consideration of "ectopic pregnancy," emergency laparoscopic surgery was performed. However, no clear lesions and bleeding points were detected during the operation. On postoperative day 2, hemoglobin level dropped sharply, meanwhile serum hCG increased significantly. Subsequent ultrasound showed a 4.4 x 4.1 x 2.6 cm gestational sac-like echo below the spleen. Laparotomy detected pregnancy tissues measured 4.0 x 3.5 cm next to the splenic hilum. Finally, the splenectomy was performed. Our case suggests that early diagnosis of splenic pregnancy is very difficult, especially when other conditions are combined. Despite this, we should still enrich ourself medical knowledge and clinical experience, and try to avoid the occurrence of splenic rupture.