Spontaneous Rupture of Internal Iliac Artery in Pregnancy: Case Report

Abstract

SUMMARY – Rupture of the internal iliac artery is a rare complication in pregnancy that is associated with maternal and fetal morbidity and mortality. We present a case of a 30-year-old primipara admitted to our department in 39 th week of gestation after sudden onset of intense abdominal pain. On admission, the patient was pale, tachycardiac, but with normal blood pressure and afebrile. Symptoms of acute abdomen were clear and surgery was indicated. Diagnosis was confirmed during cesarean section. Enlarged gravid uterus compressed the ruptured artery and prevented heavier bleeding. Acute bleeding due to arterial rupture causes severe symptoms, predominantly abdominal pain. Changes in blood count become significant some time after the onset of rupture. As the gravid uterus compressed the arterial rupture, preoperative bleeding was by far less abundant than the bleeding after the baby had been delivered and the size of the uterus decreased. Any cause of acute abdomen during pregnancy (abruption of the placenta, spleen rupture, visceral artery thrombosis) requires urgent surgical treatment, as well as intraoperative and postoperative intensive treatment. Rupture of the internal iliac artery is a rare complication in pregnancy, but has to be considered as a differential diagnosis of abdominal pain.

Spontaneous Rupture of Venae Gastricae Breves in Pregnancy: Case Report

“…Non-obstetric bleedings in pregnancy are rare, but can be fatal for both mother and foetus. After exclusion of the pregnancy-related causes of bleeding, in case of a pregnant woman with the clinical picture of acute abdomen or haemorrhagic shock it is necessary to suspect intra-abdominal bleeding of non-obstetric aetiology (12). Based on the clinical picture of the mother, it is necessary to make a decision on an emergency surgical procedure, and depending on the gestational age and the foetal status, to indicate the completion of pregnancy with a caesarean section.…”

True Saccular Aneurysm at the Iliac Bifurcation in an Adolescent: Case Report and Review of Lower Limb Vascular Embryology

“…Pregnancy in particular may confer added risk in the setting of known iliac and aneurysmal disease; spontaneous rupture of the iliac arteries has been reported both with and without aneurysmal disease present. 9 …”

Spontaneous Uterine Vessel Rupture During Pregnancy or in the Puerperium: A Review of the Literature

“…The most common presenting symptoms were abdominal pain (occurred in 69 cases), 4,8–19,21–38,40–45,48–65 nausea (13 cases), 12,26–28,30,35,40,41,44,61,62 vomiting (9 cases), 8,26,27,30,35,40,44,62 syncope (12 cases), 8,9,12,18,30,32,52,64 and dizziness (10 cases) 15,27,31,41,58,68 …”

“…The most common findings on initial evaluation were hypotension (occurring in 40 cases), 4,9,10,12–16,18,20,21,23–25,27–32,36,37,41,42,44,48,49,51–55,60,61,64,65,67,69 tachycardia (35 cases), 10,12,15,16,18,21,23,25,26,29–33,37,39,41,49,51–56,60,64,65,67,71 and peritoneal signs (30 cases) 9,12,18,21–26,28,33,38,41,43–45,48,49,51,52,54–58,64,65,67,68 . Other findings include severe anemia, defined as hemoglobin less than or equal to 7.0 g/dL (13 cases), 4,12,17,22,33,35,37,39,42,43,67,69,71 fetal demise (10 cases), 9,25,27,30,32,33,37,64 and fetal heart rate abnormalities (11 cases) 17–21,29,36–38,42,44,47,52,54,61,62,68 …”

“…9,12,18,21-26,28,33,38,41,43-45, 48,49,51,52,54-58,64,65,67,68 Other findings include severe anemia, defined as hemoglobin less than or equal to 7.0 g/dL (13 cases), 4,12,17,22,33,35,37,39,42,43,67,69,71 fetal demise (10 cases), 9,25,27,30,32,33,37,64 and fetal heart rate abnormalities (11 cases). [17][18][19][20][21]29,[36][37][38]42,44,47,52,54,61,62,68 The reported differential diagnoses were broad and included placental abruption (26 cases), uterine rupture (12 cases), appendicitis (7 cases), hemoperitoneum of unknown origin (6 cases), ruptured splenic artery (3 cases),…”