Sudden death due to non-traumatic rupture of splenic artery aneurysm

Abstract

Introduction Splenic artery aneurysm is a rare form of vascular pathology that carries a high risk of mortality once it gets ruptured. It has a prevalence of 1% and occurs due to thinning and dilatation of the arterial wall. Case We describe a case of a 35-year-old policeman who died suddenly. At medico-legal autopsy, intraperitoneal clotted blood about 1000 g and liquid blood about 3000 ml were seen. On further exploration, ruptured splenic artery aneurysm about 2.0 cm in diameter became visible near the hilum. Conclusion Rare cases typically present as sudden and unexpected death with intraperitoneal bleed and may be confused with blunt trauma abdomen. Therefore, splenic artery aneurysm is an appropriate differential diagnosis for sudden deaths and intraperitoneal bleeding, respectively.

Spontaneous Rupture of Splenic Artery Aneurysm

“…Aneurysmal rupture has been reported in 3%-10% of all splenic aneurysms, and it can cause a dramatic hypotensive shock with a high mortality rate [ 6 ]. The risk of rupture is higher in larger aneurysms, with a cutoff of 2 cm in diameter used as a high-risk feature [ 2 ]. Additional risk factors include pregnancy, cirrhosis, and liver transplantation [ 8 ].…”

“…Splenic artery aneurysm is a rare condition with an estimated prevalence of 1% in the general population [ 1 , 2 ]. However, it is the third most common arterial aneurysm, only exceeded by aneurysms in the abdominal aorta and iliac arteries.…”

“…Although the pathogenesis is not fully understood, risk factors include fibromuscular dysplasia, collagen vascular diseases, female gender, history of multiple pregnancies, and portal hypertension [ 2 , 4 ]. As elsewhere, true aneurysms involve the three layers of the arterial wall, while pseudoaneurysms lack one or more of the arterial layers, which explains the higher risk for rupture [ 4 ].…”

“…Patients typically present in the sixth or seventh decade of life with nonspecific abdominal pain, although splenic artery aneurysms can also be asymptomatic [ 4 ]. When ruptured, they can have a catastrophic presentation with intraperitoneal hemorrhage and hypovolemic shock, which has a high mortality rate (25%-75%) [ 2 , 3 ].…”

Endovascular treatment of splenic artery aneurysm rupture - Case Report

“…Typically asymptomatic, these aneurysms are often incidentally diagnosed. However, upon rupture, they can precipitate a catastrophic presentation marked by intraperitoneal hemorrhage and hypovolemic shock, carrying a mortality rate ranging between 25-75% [1,3].…”