罕见脾异位妊娠临床误诊分析及多学科救治经验OA

Objective To investigate the clinical characteristics of splenic ectopic pregnancy(SEP),to analyze the causes of misdiagnosis,to propose measures to prevent misdiagnosis,and to share the experience of multidisciplinary team(MDT)treatment.Methods A retrospective analysis was conducted on the clinical data of one patient with SEP misdiagnosed as ectopic pregnancy complicated by traumatic splenic rupture and treated in March 2024.Results The patient was admitted to the hospital due to abdominal pain for 2 h.The abdominal pain occurred after the impact of the upper abdomen,initially in the left upper quadrant,and later involved the whole abdomen.Emergency ultrasound showed massive pelvic and abdominal effusion,with no intrauterine gestational tissue,urine pregnancy test was positive.The initial diagnosis was ectopic pregnancy with traumatic splenic rupture,and hemorrhagic anemia.After comprehensive preoperative evaluation and MDT consultation,emergency laparoscopic exploration was performed.During the operation,a large amount of hemoperitoneum and blood clots were found in the pelvic and abdominal cavity,and the uterus and double adnexa appeared normal,with no active bleeding or rupture on the surface.Upon further exploration upward,a large amount of blood clots was found accumulated in the left upper quadrant of the abdomen,and after the blood clots were removed,a mass with active bleeding was found on the dorsal surface of the spleen near the lower pole.After full communication with the family,a splenic mass resection was performed.Postoperative pathology showed trophoblast cells and villi in the spleen tissue,which was consistent with ectopic pregnancy.The misdiagnosis lasted 2 d.After MDT treatment following diagnosis,the patient was cured and discharged on the 7th day after surgery.Conclusion When women of reproductive age present with abdominal pain,a comprehensive assessment of the possibility of ectopic pregnancy is necessary,with particular attention to rare implantation sites to reduce the risk of missed or misdiagnosis.Early MDT treatment is crucial for the successful diagnosis and treatment of SEP.