Primary splenic pregnancy: A diagnostic and Therapeutic Enigma of Ectopic Pregnancy

Primary splenic pregnancy is a rare type of ectopic pregnancy which can be life-threatening. Intra-abdominal bleeding is one of the major causes of emergency in primary splenic pregnancy. To date, about 51 cases have been reported globally. Hence, researchers conducted a study to identify the fundamental steps of the diagnosis necessary to reduce the mortality rate simultaneously evaluating the available therapeutic options.

Researchers presented the diagnostic-therapeutic pathway of a 22-year-old woman with primary splenic pregnancy. To identify the best treatment for these patients, researchers reviewed various databases in English and all available non-English literature, including historical publications. The collected literature was classified each article by clinical onset, diagnostic and therapeutic strategy, and histological findings, if available.

Findings:

• About 43 cases in the English-language literature were reviewed (plus another paper in German).
• The study found that 72.7% of patients presented in an emergency setting.
• Seventy-five percent of patients required splenectomy, 6.8% received pharmacological-only therapy, and 11.3% received arterial embolization before definitive treatment.
• The other ones received non-radical surgical treatment.

Primary splenic pregnancy poses significant diagnostic and therapeutic challenges due to its rare presentation. Various treatment approaches that are used, such as pharmacological, interventional, or surgical should be personalized based on the clinical presentation and hemodynamic stability of the patient. The study highlighted the necessity of developing and validating evidence-based treatment strategies to improve clinical outcomes.

Further reading: Primary splenic ectopic pregnancy: A case report and literature review of a rare issue. Doi:https://doi.org/10.1111/jog.16154