Spontaneous Rupture of Spleen in a Pregnant Armenian Woman with Favourable Pregnancy Outcome: Case Report

摘要

Background: Spontaneous or traumatic rupture of spleen in pregnancy is a rare event with catastrophic consequences. This report presents a case of spontaneous splenic rupture of a pregnant woman with thrombophilia in complicated somatic history and successful cesarean section with maternal and infant survival. Case: A 28-year-old Armenian woman at 35 weeks of gestation presented to the Emergency Department at “Erebouni” medical center in Yerevan, Armenia with sharp pain in the epigastric region, general weakness and worsening condition. The patient was immediately transferred to the operating room. All clinical-laboratory examinations were urgently carried out, the fetus condition began to be assessed under the control of the CT. She was in obvious distress with blood pressure of 90/50 mm Hg and a pulse rate of 80 - 70 beats per minute. Abdominal ultrasound confirmed free fluid in the peritoneal cavity. Cesarean section was performed on the lower segment of the uterus. A live premature female infant was born weighing 2580 g, height 48 cm, and with an Apgar score of 7 - 8 points. Then the integrity of the uterus was restored. Abdominal rehabilitation was performed, there were about 1000 ml of blood loss and continuous internal bleeding. Doctors found splenic ruptures around the perineum. Lower middle laparotomy, splenectomy, abdominal rehabilitation, drainage were performed. Conclusion: This case illustrates the need to consider ruptured spleen as part of differential diagnosis of hemoperitoneum in pregnant women. Immediate surgical intervention is needed to ensure survival of mother and fetus.