Splenic Artery Aneurysm Rupture in Pregnancy [6K

Abstract

INTRODUCTION: Splenic artery aneurysm (SAA) is the third most common intraabdominal aneurysm. Splenic artery aneurysm rupture is a rare, but life-threatening complication of pregnancy. We present a case of splenic artery aneurysm rupture in labor where prompt diagnosis with multidisciplinary intervention resulted in a favorable maternal and fetal outcome. METHODS: A 24-year-old woman, gravida 1 para 0 at 39 weeks of gestation presented to labor and delivery unit for a scheduled induction of labor for gestational hypertension. During the course of induction of labor, patient had an abrupt onset of nausea and chills associated with hypotension and tachycardia. Fetal heart rate deceleration was noted and the patient was taken for a stat cesarean section due to persistent fetal bradycardia and worsening maternal clinical status. RESULTS: Intraoperatively significant hemoperitoneum was noted with no evidence of uterine rupture. Further abdominal exploration by the surgical team revealed a splenic artery aneurysm rupture. Patient underwent a splenectomy and splenic artery ligation. The patient was stabilized and transferred to the intensive care unit for further monitoring. CONCLUSION: Splenic artery aneurysm rupture is associated with a very high maternal and fetal mortality of 75% and 95% respectively. The prevalence of splenic artery aneurysm is noted to be 0.1–0.2% in general population from autopsy studies. The changes associated with pregnancy increase the risk of formation and rupture of the aneurysm. Symptoms are nonspecific and the diagnosis is often times made during laparotomy. Prompt diagnosis and a concerted team effort is essential as in this case for maternal and fetal survival.