Vaginal misoprostol for salvage therapy after failed medical abortion

which the spleen is free to move from its normal anatomical position to the lower abdomen or pelvis. A congenital form can occur where the suspensory ligaments, which normally ensure splenic fixation, fail to develop [1]. An acquired type can occur in conditions that weaken ligaments, such as pregnancy — which explains the increased incidence of ectopic spleen in multiparous women [1]. Conditions causing splenomegaly, such as leukemia and lymphomas, also seem to increase splenic mobility [1]. The patient in this case report was multiparous, and chronic myeloid leukemia had caused splenomegaly. An ectopic spleen can present as an abdominal or pelvic mass with or without pain. It may also present as an acute surgical abdomen owing to the torsion of the splenic pedicle [2], and in which case the mortality rate is worse [2]. Symptoms are usually due to the pressure exerted on the surrounding organs. Although various imaging modalities, such as computed tomography, magnetic resonance imaging, and Tc-99m sulfur colloid imaging, can be used to diagnose this uncommon condition, Doppler ultrasonography is a simple and reliable investigationwith the added advantage of measuring the organ blood flow [3]. Asymptomatic patients can be followed up with serial Doppler ultrasonographic evaluations [3]. Splenopexy should be considered in children, but splenectomy is the treatment of choice for complications such as infarction, gangrene, and subcapsular hematoma [4]. In summary, a high index of clinical suspicion is required in the diagnosis of this rare condition.