Splenic Rupture in an Elective Cesarean Section: A Possible Iatrogenic Event

Abstract

A rare case of an unexpected iatrogenic splenic rupture during a cesarean section is reported. The trauma was recognized early and treated conservatively without delay; thus, further complications were avoided. A 28-year-old woman with a history of previous cesarean sections was submitted for an elective cesarean section. Intra-operatively, minor bleeding from the left abdomen was noted and eventually assigned to an inferior pole splenic trauma treated conservatively without splenectomy. Although unclear, the injury was considered iatrogenic, probably due to the abdominal pressure for fetal delivery and the anatomy of the splenocolic ligament. This case highlights the clinical suspicion that is required despite routine surgical procedures for the early diagnosis of an unexpected splenic rupture when minor bleeding occurs intraoperatively from the upper abdomen. Early recognition and prompt treatment are of paramount importance for the safety of the fetus and the patient.

A Splenic Rupture Following a Singleton Spontaneous Vaginal Delivery: The First-Known Case Report in Saudi Arabia

“…Antepartum and postpartum hemorrhages are currently the leading cause of maternal mortality and longterm morbidity worldwide. It may be due to either medical, surgical, or obstetrical factors [1]. A spontaneous or non-traumatic splenic rupture is a rare occurrence in the setting of a healthy spleen during pregnancy [2].…”

“…A spontaneous or non-traumatic splenic rupture is a rare occurrence in the setting of a healthy spleen during pregnancy [2]. It is defined to occur in the absence of any associated splenic trauma, systemic disease, and absent evidence related to splenic adhesions [1]. Due to its nonspecific symptoms following delivery; the diagnosis is sometimes confusing and subsequently delayed, which can lead to adverse outcomes [3].…”

“…However, the mechanism and cause of injury in some cases is multifactorial and unclear. Several authors have considered that pregnancy itself is a risk factor for splenic rupture, which is explained by hypovolemia and alteration in abdominal organs caused by pregnancy changes [1,4]. Another cause of splenic rupture is iatrogenic, which involves involuntary damage to the spleen during a surgical operation or intervention such as performing fundal pressure (Kristeller maneuver) during the second stage of labor.…”