Rupture of Splenic Artery Aneurysm During Pregnancy: Three Case Reports with a Review of the Literature

Abstract

AA Algwiser, Rupture of Splenic Artery Aneurysm during Pregnancy: Three Case Reports with a Review of the Literature. 1991; 11(2): 221-225 Aneurysms of the splenic artery are rare. They remain silent until rupture. Because of their frequent association with pregnancy, this is a topic of special interest to obstetricians, particularly because of the difficulty in diagnosis and because it carries a very high maternal and fetal mortality. We report three cases of ruptured splenic artery aneurysm occurring in the third trimester of pregnancy and puerperium, bringing the total number of cases reported in the literature to 75. Case Reports Patient 1A 32-year-old Saudi woman (para 5, gravida 8) was admitted on 12 October 1987 at 2240 hours. Since 1300 hours she had had shortness of breath, nausea, epigastric and shoulder pain, and abdominal pain, especially over the right iliac fossa. On admission, her temperature was 37°C; pulse, 84 per minute; and blood pressure, 115/70 mm Hg. Fundal height corresponded to 38 weeks' gestation with a cephalic presentation. Fetal heart sounds were audible. The abdomen was soft, and cardiotocography showed a reactive tracing with mild uterine contractions. Vaginal examination revealed a parous cervical os, uneffaced cervix, and a high presenting part. Pulse was 80 per minute; blood pressure, 110/70 mm Hg; there was proteinuria+ but the abdomen was soft. There were no uterine contractions and no bleeding per vaginam. An intravenous line was started and the patient was given 10 mg of metoclopramide hydrochloride intramuscularly and discharged home. At 0815 hours, her condition deteriorated and she was readmitted. She was pale and hyperventilating, and her pulse had risen to 140 per minute with blood pressure dropping to 100/80 mm Hg. Her abdomen became tense and painful, and fetal parts were impossible to palpate. An urgent ultrasound was carried out which was suggestive of abruptio placentae. The patient was rushed to the obstetric theatre for emergency cesarean section. The abdomen was entered through a subumbilical midline incision and about 1,500 ml of blood was encountered in the peritoneal cavity. No bleeding source could be found.A male infant, weighing 2,760 gm with an Apgar score of 5 at 1 minute and 5 at 5 minutes, was delivered by lower-segment cesarean section. After closure of the uterus, there was no evidence of further hemorrhage in the abdominal cavity, so the abdomen was closed. While the patient was still in the recovery room, her condition deteriorated. Her pulse rose, she became pale, and the abdomen became distended. Her hemoglobin dropped to 36 gm/L. In view of this, the abdomen was re-entered through the previous incision, which was extended upward to the left costal margin. Three liters of blood clot were found in the peritoneum. At first the bleeding was thought to originate from the liver or stomach, as the uterus was intact and well contracted, but after blood was evacuated from the abdominal cavity, it was obvious that the source of bleeding was from a ruptu...

Splenic artery aneurysm rupture during pregnancy: A case report of maternal and fetal survival

“…If we had accurately born in mind abdominal vascular collapse during pregnancy, an earlier diagnosis of SAA rupture might have been achieved based on a more meticulous exploration at the time of caesarian section. Some obstetricians have suggested that a midline incision rather than a Pfannenstiel incision should be primarily selected for caesarian section when intraperitoneal hemorrhage is suspected [ 13 ].…”

“… No. Author Year Age (years) Gestation (weeks) Gravida, Para Way of diagnosis for SAA rupture Definitive treatment for SAA rupture 1 Gibbens [ 17 ] 1974 41 No data 0, 0 Exploration during cesarean section Splenectomy and ligation of splenic artery 2 Algwiser [ 13 ] 1991 32 38 8, 5 Exploration by relaparotomy following cesarean section Splenectomy 3 Al Asfar [ 18 ] 2005 33 42 0, 0 Exploration during cesarean section Splenectomy with excision of SAA 4 Perino [ 19 ] 2012 39 35 multiparous Exploration during cesarean section Ligation of splenic artery 5 Corey [ 11 ] 2014 29 35 multiparous Exploration during cesarean section Splenectomy with excision of SAA and pancreatic tail 6 Garey [ 20 ] 2014 26 36 2, 3 Exploration ...…”