Management of splenic artery aneurysm rupture during trial of scar with epidural analgesia

Fender, Guy; Haslett, Elizabeth; Leary, Tim; Bland, Elaine

doi:10.1016/s0002-9378(99)70682-4

Cited by 17 publications

(10 citation statements)

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“…Hypotension resistant to vasoactive drugs and breakthrough pain 2006, 61, pages 187-189 . ..................................................................................................................................................................................................................... Ó 2006 The Authors occurring with regional analgesia are also reported as warning signs of a more serious diagnosis [5,9]. Rare presentations have included gastrointestinal symptoms such as vomiting and diarrhoea with abdominal pain [10].…”

Section: Discussionmentioning

confidence: 99%

“…In many instances, the symptoms were initially attributed to more common obstetric conditions, such as uterine scar rupture or placental abruption and the diagnosis was only made after emergency Caesarean section revealed free blood in the peritoneum, and the incision converted to a midline approach. Hypotension resistant to vasoactive drugs and breakthrough pain occurring with regional analgesia are also reported as warning signs of a more serious diagnosis [5, 9]. Rare presentations have included gastrointestinal symptoms such as vomiting and diarrhoea with abdominal pain [10].…”

Section: Discussionmentioning

confidence: 99%

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Ruptured splenic artery aneurysm in pregnancy presenting in a manner similar to pulmonary embolus

2006

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SummaryWe report a patient, 33 weeks pregnant with twins, who sustained a ruptured splenic artery aneurysm. This presented with left sided chest pain, breathlessness, low oxygen saturations and electrocardiogram (ECG) changes supportive of a diagnosis of massive pulmonary embolus. The diagnosis of splenic artery rupture was made at emergency Caesarean section performed for fetal distress. Ruptured splenic artery aneurysm in pregnancy is a rare but well described condition, which carries a high mortality risk for mother and child. Among the visceral aneurysms, splenic artery aneurysms are relatively common, and the risk of rupture is increased by pregnancy, parity and portal hypertension. The incidence is between 0.16% and 0.78%, and half of all ruptures occur in pregnancy, with fetal and maternal mortality rates of 95% and 68.7-75%, respectively [1]. The majority are asymptomatic until rupture, when they may present with cardiovascular collapse in association with upper abdominal, flank, or left shoulder tip pain. Case reportAn 18-year-old woman with a 33-week twin pregnancy presented for obstetric review with intermittent lower abdominal pain, suggesting the possibility of preterm labour. On arrival at the delivery suite, the pain had settled and she was admitted to the prenatal ward for observation. She was in good health with no previous medical conditions and no disorders arising from pregnancy. Specifically, she had no history of liver disease or drug abuse and no family history of connective tissue diseases.During the night, she rang for assistance and reported to the midwife who attended her that she had severe shortness of breath, left-sided chest and shoulder tip pain. She then lost consciousness. Initial assessment revealed a patent airway, tachypnoea with use of accessory muscles of respiration, and central cyanosis. Pulse oximetry consistently gave oxygen saturations of 60-70%. Pulse was 140 beats.min )1 and blood pressure was unrecordable. There was no blood loss on vaginal examination. Glasgow coma score was 9. High-flow oxygen was administered, intravenous access obtained and 1 l of gelofusine infused rapidly. Her level of consciousness subsequently improved dramatically and she was able to indicate that she had severe breathlessness and substernal chest pain. She denied any abdominal pain. Oxygen saturations remained at 60-70%. Her ECG showed a sinus tachycardia of 150 beats.minwith a normal axis, non-significant Q waves in leads III and aVF, and T wave inversion in lead III (Fig. 1).The history, examination and ECG were felt to be consistent with a diagnosis of massive pulmonary embolus. In view of persistently low oxygen saturations, anaesthesia was induced and ventilation of the lungs with oxygen (F i O 2 > 0.9) commenced. Oxygen saturations improved to 99%.Ultrasound examination revealed severe fetal bradycardia, and emergency lower segment Caesarean section was performed in the room in an attempt to save the twins. On incising the peritoneum, a large quantity of blood was

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Ruptured splenic artery aneurysm in pregnancy presenting in a manner similar to pulmonary embolus

2006

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“…34 Fender et al reported a case in which the clinical signs of rupture were hidden by epidural anesthesia used during delivery. 35 Abdominal sensitivity may be increased, but signs of shock are the most suggestive aspect. Abnormal cardiotocography during prenatal screening may also be observed during advanced pregnancy.…”

Section: Rupture During Pregnancymentioning

confidence: 99%

Aneurismas de artéria esplênica: história natural e técnicas de tratamento

Mariúba¹

2020

J. vasc. bras.

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True splenic artery aneurysms (SAA) are a rare, but potentially fatal, pathology. They are the third most common type of abdominal aneurysm, after aneurysms of the aorta and of the iliac artery, and account for almost the all aneurysms of visceral arteries. True aneurysms account for 60% of SAA and affect four times as many women as men, generally related to increased incidental or symptomatic findings that coincide with use of ultrasonography in pregnancy. Among pregnant patients, mortality after rupture is 65-75%, with fetal mortality exceeding 90%. There are multiple etiologies and it is believed that hormonal influences and changes in portal flow during gestation play an important role in development of SAA. This review discusses their history, epidemiology, pathophysiology, and diagnosis and current treatment techniques. ResumoAneurismas da artéria esplênica (AAE) verdadeiros são uma patologia rara, mas potencialmente fatal. São o terceiro aneurisma abdominal mais comum, após aneurismas da aorta e da artéria ilíaca, e representam quase todos os aneurismas de artérias viscerais. Os aneurismas verdadeiros são responsáveis por 60% dos AAEs e afetam as mulheres quatro vezes mais do que os homens, geralmente relacionados a uma descoberta incidental ou sintomática aumentada que coincide com o uso da ultrassonografia na gravidez. Em pacientes grávidas, a mortalidade, após a ruptura, é de 65-75%, com mais de 90% de mortalidade fetal. Têm múltiplas etiologias, e acredita-se que as influências hormonais e as alterações do fluxo portal durante a gestação desempenhem um papel importante no desenvolvimento do AAE. Esta revisão discorrerá sobre sua história, epidemiologia, fisiopatologia, diagnóstico, e as técnicas atuais de tratamento. Palavras-chave: aneurisma; artéria esplênica; procedimentos endovasculares. How to cite: Mariúba JVO. Splenic aneurysms: natural history and treatment techniques. J Vasc Bras. 2020;19:e20190058.

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“…The rupture of splenic artery aneurysm is accompanied by a 25 % mortality rate [1]. When the rupture occurs during pregnancy the mortality is extremely high, with rates of maternal and fetal mortality up to 75 % and 95 %, respectively [2].…”

Section: Commentsmentioning

confidence: 99%

Rupture of splenic artery aneurysm during pregnancy and posterior evolution of gestation

Arrieta¹,

Muguerza²,

Sancho³

et al. 2000

Zentralbl Gynakol

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Management of splenic artery aneurysm rupture during trial of scar with epidural analgesia

Cited by 17 publications

References 1 publication

Ruptured splenic artery aneurysm in pregnancy presenting in a manner similar to pulmonary embolus

Ruptured splenic artery aneurysm in pregnancy presenting in a manner similar to pulmonary embolus

Aneurismas de artéria esplênica: história natural e técnicas de tratamento

Rupture of splenic artery aneurysm during pregnancy and posterior evolution of gestation

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