Spontaneous Splenic Vein Rupture with Massive Hemoperitoneum during the Third Trimester of Pregnancy

Marchi L,Martini R,Spinelli G,Florio Pm,Feroci F,Giorgi L,Nardi V,Cavaliere Af,Garraffo C,Vicini I,Gardelli M

doi:10.36502/2021/asjbccr.6220

Marchi L, Martini R + Show 9 more

Open Access

https://doi.org/10.36502/2021/asjbccr.6220

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Abstract

We describe a case of spontaneous rupture of the splenic vein in a pregnant patient at 33 weeks gestation. For the first time in literature, we report follow-up investigations aimed at understanding the cause of the event. The woman was admitted to the emergency ward for hypovolemic shock. Maternal and fetal distress prompted an immediate cesarean section. The fetus was delivered stillborn, hemoperitoneum was present and two spontaneous splenic vein’s lacerations were found to be the source of the bleeding. The immediate splenectomy and aggressive correction of anemia and coagulopathy determined maternal survival. During the follow-up, no evidence of neither congenital nor acquired causative factors for a splenic vein rupture was found. The aim of reporting this case is to increase the awareness between clinicians of this condition since it is both rare and with an aspecific clinical picture. It presents itself in apparently low-risk patients and a good maternal-fetal outcome can only be achieved by early diagnosis and prompt treatment.

Highlights

Spontaneous rupture of the splenic vein is a rare occurrence
For the first time in literature, it is available a detailed follow up of the patient, by which we demonstrated that she did not suffer from any disease that might be accounted to be the definitive cause of the splenic vein rupture: no congenital aneurism was present, nor an inherited or acquired connective tissue disease, nor an acquired disorder that might have caused an increase in blood pressure in the lineal vessels
Spontaneous rupture of the splenic vein may occur during pregnancy

Summary

Introduction

Spontaneous rupture of the splenic vein is a rare occurrence. A number of cases of spontaneous rupture of the splenic vein have been reported to occur in pregnancy [2]. For the first time in literature, it is available a detailed follow up of the patient, by which we demonstrated that she did not suffer from any disease that might be accounted to be the definitive cause of the splenic vein rupture: no congenital aneurism was present, nor an inherited or acquired connective tissue disease, nor an acquired disorder that might have caused an increase in blood pressure in the lineal vessels. She underwent several consultations at our outpatient clinic in order to find the possible cause of the spontaneous rupture of the splenic vein. She was proven negative at screening for disorders of haemostasis except for gene II mutation

Discussion

Findings

Immediate demise

Conclusion