Abstract
BackgroundRupture of a renal artery aneurysm (RAA) during pregnancy is a rare event, with a high mortality rate for both mother and fetus. Increased blood flow and intra-abdominal pressure, and vascular changes secondary to increased steroid production are postulated as contributory to the increased risk of rupture during pregnancy.Case presentationWe present here a case report of total avulsion of solitary kidney secondary to rupture of RAA in a pregnant patient with congenital absence of the contralateral kidney. The main indication for nephrectomy was severely damaged kidney. Diagnosis was made during operation and both mother and fetus were saved. There are no previous reports of an intact renal artery aneurysm diagnosed either antepartum or postpartum.ConclusionThe possibility of a ruptured RAA should be considered in pregnant women with evidence of retroperitoneal hemorrhage. This case was unusual because it occurred in a solitary kidney, during the third trimester of pregnancy.
Highlights
Rupture of a renal artery aneurysm (RAA) during pregnancy is a rare event, with a high mortality rate for both mother and fetus
Rupture or total avulsion of the kidney secondary to rupture RAA during pregnancy is an extremely rare event, even more the obstetric and urological literatures are Deficient in this regard
We reported on a pregnant patient at 35 weeks of gestation, who had total avulsion of a solitary kidney secondary to spontaneous rupture of RAA, treated by nephrectomy with favorable outcomes
Summary
Renal artery aneurysm (RAA) occurs due to focal dilatation of the artery secondary to weakness of the arterial intima and media. A 40 year old woman, gravida 10 para 9, unbooked, presented to the emergency room, severely ill, complaining of severe acute abdominal pain since 1 hour According to her given expected date of confinement, she was 35 weeks and four days of gestation. Laboratory studies, included a complete blood cell count, chemistry, coagulation profile, and arterial blood gases, were undertaken In view of her clinical presentation, as BP was decreasing and the pulse was increasing, the provisional diagnosis was query placental abruption or rupture uterus. Within one hour BP dropped again to 100/60 mm Hg, pulse increased to 110/bpm, blood was coming from the drains and the patient was deteriorating Both surgeons were called again for re-assessment; they decided to re-explore the abdomen. Histopathological report revealed degenerative aneurysmal changes of the renal artery and acute tubular necrosis of the left kidney
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