Splenic Ectopic Pregnancy: A Rare Case Report

Abstract

Introduction Ectopic pregnancy is a significant cause of morbidity and mortality in women of reproductive age, accounting for approximately 1-2% of all pregnancies [1]. Rarely, ectopic pregnancies can occur in unusual locations, such as the ovary, cervix, or abdominal cavity. We report a case of splenic ectopic pregnancy complicated by hemoperitoneum, which was successfully managed conservatively. Case Presentation A 32-year-old woman with a history of two previous ectopic pregnancies was admitted to the Emergency Department with pain in the left side and lower abdomen, nausea, and vomiting. The final diagnosis of a splenic ectopic pregnancy was made based on anamnesis, elevated β-hCG levels, positive pregnancy test, transvaginal ultrasound that did not show an intrauterine pregnancy, and computed tomography (CT) examination findings of heterogeneous structure inferior to the spleen with hemorrhagic fluid in the pelvis. Selective angiography with coil embolization was performed to stop the bleeding from a small artery that branches off the lower pole of the spleen. The patient was treated conservatively with a two-dose regimen of methotrexate. The next day, the β-hCG level lowered to 2900 IU/L. The patient was followed up with monitoring of the dynamics of the hematoma. After two months, the β-hCG level normalized to 1.8 IU/L. CT scan was repeated after 7 months. The mass near the spleen had decreased, and the patient’s recovery was uneventful. Discussion Advancements in imaging and interventional radiology have shifted management towards minimally invasive approaches. Transcatheter arterial embolization has emerged as a key method to control bleeding while preserving the spleen [2,3]. Minimal invasive therapy combined with methotrexate minimizes surgical risks and supports better recovery outcomes. Conclusions A multidisciplinary approach and minimally invasive techniques can effectively manage splenic ectopic pregnancy, ensuring patient safety and optimal outcomes.