Sudden, Unexpected Death Due to Splenic Artery Aneurysm Rupture

Abstract

Splenic artery aneurysms are an uncommon form of vascular disease that have a significant potential for rupture, resulting in life-threatening intraperitoneal hemorrhage. We describe the case of a 33-year-old man who died suddenly and unexpectedly due to the rupture of a splenic artery aneurysm. At medicolegal autopsy, 3000 mL of fluid blood were recovered from the peritoneal cavity. The source of bleeding was a sack-like aneurysm of the splenic artery, measuring 2 cm in diameter. Histologic examination of the splenic artery aneurysm revealed fibromuscular dysplasia. No atherosclerotic lesions or any inflammatory changes were apparent within the wall of the splenic artery. Portal hypertension and pancreatitis, previously described as important factors promoting splenic artery aneurysm formation, were excluded by autopsy and histology. From the forensic pathologist's viewpoint, this rare case underlines the importance of splenic artery aneurysm rupture as a relevant differential diagnosis of intraperitoneal hemorrhage and sudden death, respectively, since such cases may be misinterpreted as a result of blunt-force trauma.

Sudden adult death

“…Syphilic aneurysms of the thoracic aorta can present similarly [279]. Acute spontaneous hemorrhage from other large vessels, for example of the splenic artery, has been recorded; this may be associated with connective tissue disorders, fibromuscular dysplasia and cystic-medial necrosis type change [280][281][282][283]. Pulmonary thromboembolus is a well recognized cause of sudden death [284], being more prevalent in the 5th to 9th decades of life and typically occurring around 15 days after trauma [285].…”

Rupture of Splenic Artery Aneurysm in Pregnancy

“…It must be considered when we encounter hemorrhagic shock in a pregnant woman without obstetric hemorrhage. 8,9 Only a few cases were successfully managed before the rupture of splenic artery aneurysm in literature, but we should learn the cases similar to rescue both mother and fetus. [11][12][13] In summary, we have described 2 cases of a pregnant woman and a postpartum woman with hemorrhagic shock and death due to the rupture of splenic artery aneurysm.…”

“…The literature suggests that pregnant women tend to be younger and have fewer adhesions from previous surgery than the general population, 2,3,7 therefore, rupture occurs almost exclusively into the free periautopsies of cases of sudden, unexpected death during pregnancy does not only serve to detect the reason for this unusual and catastrophic event, but serves also to get more information about morphologic changes in artery aneurysms and finally serves to support the clinician who must answer questions of the bereaved in cases where the cause of death is unclear. 8,9 Although an arterial aneurysm during pregnancy is rare, it can be catastrophic if it ruptures. It mostly occurs in the third trimester, during labor, or in the early postpartum period.…”

Rupture of the spleen or splenic vessels (splenic emergency syndrome) in late pregnancy: A report of two autopsy cases

“…An excessive rise in blood pressure or arterial flow can injure the vascular wall, inducing arterial fibromuscular dysplasia (FMD), frequently associated with cervical artery dissection [13] and sometimes with splenic artery aneurysms [9]. The most common form is medial fibromuscular dysplasia, which accounts for more than 95% of cases.…”

“…We report two cases of death of young women in the third trimester of pregnancy, caused by rupture of an aneurysm of the splenic artery in one case and by splenic hemorrhage in the other. A review of the literature on similar cases emphasizes the morphological changes of the splenic arteries that may be correlated with these events [1,[3][4][5][7][8][9]]. …”