Background: Ectopic pregnancy in the upper abdominal organs is very rare but has been known to occur in the liver, spleen and lesser sac. Primary splenic pregnancy is considered the rarest form of extrauterine pregnancy, with only few well-documented cases reported.
Case: Intraperitoneal bleeding and shock resulted from a primary splenic pregnancy in a 37-year-old woman.
Conclusion: Primary splenic pregnancy usually presents with upper left abdominal pain and intraperitoneal bleeding. It requires an emergency splenectomy and should be considered in the differential diagnosis of acute abdomen in reproductive-age women.