Spontaneous rupture of spleen in the second trimester: Case Report and Literature Review

Background Spontaneous rupture of the spleen during pregnancy or after Delivery is an extremely rare, harmful and life-threatening complication that poses a major challenge to diagnosis and treatment. It also reviews the relevant literature to discuss the characteristics of patients with prenatal spontaneous splenic rupture. Case presentation A 33-year-old woman with spontaneous splenic rupture at 27 weeks of gestation is presented here in a case study. Despite the absence of a history of trauma and recognized risk factors, the patient exhibited symptoms of polyhydramnios accompanied by abdominal distension one week prior. One week later, the patient presented to the emergency department. They had an abdominal ultrasound. This revealed a large amount of ascites. This was not seen on a whole abdominal CT. This was to identify the location of bleeding. The patient also had a progressive decline in hemoglobin. There was also abnormal fetal umbilical artery blood flow. After a multidisciplinary consultation, emergency c-section and exploratory laparotomy were performed. The departments involved were surgery, gynecology, obstetrics, ultrasound, radiology and neonatology. After delivery of the fetus, exploration revealed an active haemorrhage. This was near the splenic hilum on the greater omentum. There was also a ruptured capsule at the splenic hilum. Following consultation with the surgeon and with the family's consent, a complete splenectomy was performed. The diagnosis of spontaneous splenic rupture was confirmed by postoperative paraffin-embedded pathology. This is a very rare case. Excessive amniotic fluid, increased abdominal pressure and rupture of the greater omentum and splenic capsule after omental traction are the current causes for concern. These result in intraperitoneal haemorrhage and haemorrhagic shock. Conclusion This case emphasizes the importance of monitoring amniotic fluid volume during pregnancy closely, as well as the early monitoring, diagnosis and treatment of acute abdomen induced by polyhydramnios. Active surgical intervention will help to improve maternal outcomes and prognosis.