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COITAL RUPTURE OF THE SPLEEN
Author(s) -
Mahmood A.
Publication year - 1970
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/j.1471-0528.1970.tb03589.x
Subject(s) - obstetrics and gynaecology , citation , medicine , gynecology , library science , computer science , pregnancy , biology , genetics
CASE REPORT A housewife, aged 36, who had had three children, was admitted as an emergency case at 4 p.m. on 10th August, 1969. She stated that severe lower abdominal pain started immediately following intercourse in the supine position at 7 a.m. on that day. The pain was worse on movement and was referred also to her shoulders. Later in the day she had a stabbing pain in the left lower chest on deep breathing and coughing. She felt faint and nauseated but did not vomit. There was no history of vaginal bleeding, or of urinary or bowel symptoms. Her menses were normal; her last menstrual period being on the 21st July, 1969. She had had no abnormal bleeding tendency. She looked pale and distressed but was not shocked. Her temperature was 36.7 "C., pulse 104 per minute, blood pressure 100/70 mm. Hg. There was generalized abdominal tenderness with guarding, most marked in the right lower quadrant. The bowel sounds were normal and the femoral pulses were present. There was no obvious mass in the abdomen; the liver, spleen and kidneys were not palpable. On vaginal examination no bleeding or laceration was seen. There was severe pain on moving the cervix and an ill-defined, extremely tender, swelling in the right fornix. A diagnosis of intraperitoneal haemorrhage was made. Laparotomy was performed through a Pfannenstiel incision. About 500 ml. of blood were present in the peritoneal cavity, mostly clots, mainly in the right side of the pelvis. The uterus, uterine tubes and ovaries were normal, apart from a follicular cyst about 2 cm. in diameter in the right ovary. It was observed that fresh blood was trickling down from the upper abdomen, so the Pfannenstiel incision was closed and the abdomen opened through an upper left paramedian incision. A laceration about 5 mm. long on the upper pole of the spleen was found and splenectomy was performed. She was given 2200 ml. of blood during and soon after the operation. Her recovery was uneventful. Apart from the small laceration on the upper pole the spleen was normal macroscopically and microscopically.