A MISSED SPONTANEOUS SPLENIC RUPTURE IN A NIGERIAN NEONATE - A RARE AND CHALLENGING CASE REPORT AND REVIEW OF LITERATURE.

Background: Splenic rupture is relatively uncommon in newborns but could occur from birth trauma, increase intra-abdominal pressure such as polyhydramnios and fetal ascites. Abdominal ultrasonography remains the radiologic investigation of choice in this clime. We present this rare finding, first in the literature from sub-Saharan Africa, to raise awareness, and improve our index of suspicion of this extremely fatal condition. Case summary: A 2-day old male who was delivered via elective caesarian section at 39 weeks gestational age. He cried well at birth but was noticed to have a distended abdomen and respiratory distress 4 hours after birth with a reduction of the packed cell volume from 40% at 5 hours of life to 23% on the second day after birth. Abdominal ultrasound scan showed hepatosplenomegaly with moderate ascites. An initial diagnosis of malrotation with midgut volvulus was made. Exploratory laparotomy was done on the 36th hour of life after optimization of the hematocrit level with intra-operative findings of a 3cm sub capsular splenic laceration and 100 mls of haemoperitoneum with clots. The bleeding point was identified and a haemostatic agent applied. Six hours post-surgery, he suffered a cardiopulmonary arrest and all efforts at resuscitation were unsuccessful. Conclusion: Management of this condition may be non-operative or surgical. Irrespective of the treatment approach, it is associated with high mortality in the setting of delayed diagnosis and intervention. Thus, it is important to have a high index of suspicion on any neonate.