Heterotopic simultaneous splenic and intrauterine pregnancy after spontaneous conception and review of literature.

A 31-year-old woman presented to the emergency department with sudden onset left upper quadrant pain radiating to the left shoulder. Urine β-hCG test was positive. Transvaginal sonography was suggestive of ruptured ectopic pregnancy with a large amount of free fluid in the pouch of Douglas. The patient was then taken for emergency laparoscopy. On laparoscopy, hemoperitoneum was noted but both the fallopian tubes and ovaries were normal. On further exploration, bleeding was noted from the spleen so laparotomy was performed and emergency splenectomy was carried out by a surgeon. The histopathology report of the spleen confirmed a splenic ectopic pregnancy. On postoperative follow-up, the patient's quantitative serum β-hCG started rising again, which raised suspicion of another pregnancy. After serial β-hCG and ultrasound, a failed intrauterine pregnancy was diagnosed. Suction evacuation was performed, with histopathology confirming products of conception.