Postpartum splenic rupture

Spontaneous splenic rupture in pregnancy is rare and occurs most commonly in the third trimester or puerperium.

In the first case, an eclamptic woman had postpartum uterine atony that necessitated hysterectomy. She was reexplored for increasing abdominal girth and evidence of hemoperitoneum on computed tomography scan. An actively bleeding defect was noted in the spleen, necessitating splenectomy. In the second case, a patient with cholestasis of pregnancy developed persistent bleeding after manual removal of the placenta, requiring a suction curettage followed by hysterectomy. Reexploration because of a dropping hematocrit revealed a capsular defect on the spleen, for which splenectomy was performed.

A high index of suspicion of postpartum splenic rupture is imperative because delay in the diagnosis can lead to catastrophic consequences. Thus, it is vital to evaluate the entire abdomen in posthysterectomy hemoperitoneum.