Splenic ectopic pregnancy is extremely rare but carries a high risk of life-threatening intraperitoneal bleeding. Here, we present a 40-year-old woman presenting with vaginal bleeding. Although the intrauterine device (IUD) had been in place for 6 years, urinary and serum tests were positive for pregnancy. However, transvaginal ultrasound showed an empty uterus, no apparent adnexal masses or free fluid. An abdominal ultrasound was subsequently performed, which revealed a viable gestational sac in the spleen. An MRI that did not induce ionizing radiation was also performed, confirming the diagnosis of this splenic pregnancy. The gastrointestinal surgeon completed a laparotomy which successfully removed the spleen's superior pole containing an ectopic pregnancy.
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