Splenic Rupture in Pregnancy Necessitating Antepartum Splenectomy

Splenic rupture most commonly results from blunt abdominal trauma or splenomegaly associated with infection. Diagnosing splenic injury during pregnancy is particularly challenging because its clinical signs and symptoms overlap with those of other common causes of acute abdominal pain in pregnancy. We report the case of a previously healthy 25-year-old woman (gravida 6, para 2, abortions 3, living 2) at 28 weeks and 5 days of gestation who presented with the acute onset of left upper quadrant (LUQ) abdominal pain. She had sustained mild direct abdominal trauma, followed by three weeks of progressively worsening left-sided chest pain radiating to the shoulder. Clinical evaluation and imaging revealed hemorrhagic shock and hemoperitoneum secondary to splenic injury. The patient underwent a successful exploratory laparotomy and splenectomy, during which a splenic laceration was identified. Postoperatively, she was diagnosed with infectious mononucleosis and subsequently had an uncomplicated full-term delivery. This case highlights the importance of thorough evaluation of acute abdominal pain during pregnancy and demonstrates that splenectomy can be safely performed during the third trimester when clinically indicated.