Rupture of splenic artery aneurysm in a pregnant patient with portal hypertension

Hillemanns, Peter; Knitza, R.; Müller‐Höcker, Josef

doi:10.1016/s0002-9378(96)70632-4

Cited by 48 publications

(25 citation statements)

References 2 publications

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“…[31][32][33] High estrogen levels, increased blood flow from pregnancy and portal hypertension are the likely underlying mechanisms. Splenic artery aneurysmal rupture may occur in 2.6% of pregnant women with cirrhosis of liver.…”

Section: Splenic Artery Aneurysm Rupturementioning

confidence: 99%

Pregnancy with Portal Hypertension

Aggarwal

Negi

Aggarwal

et al. 2014

Journal of Clinical and Experimental Hepatology

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Even though pregnancy is rare with cirrhosis and advanced liver disease, but it may co-exist in the setting of noncirrhotic portal hypertension as liver function is preserved but whenever encountered together is a complex clinical dilemma. Pregnancy in a patient with portal hypertension presents a special challenge to the obstetrician as so-called physiological hemodynamic changes associated with pregnancy, needed for meeting demands of the growing fetus, worsen the portal hypertension thereby putting mother at risk of potentially life-threatening complications like variceal hemorrhage. Risks of variceal bleed and hepatic decompensation increase many fold during pregnancy. Optimal management revolves round managing the portal hypertension and its complications. Thus management of such cases requires multi-speciality approach involving obstetricians experienced in dealing with high risk cases, hepatologists, anesthetists and neonatologists. With advancement in medical field, pregnancy is not contra-indicated in these women, as was previously believed. This article focuses on the different aspects of pregnancy with portal hypertension with special emphasis on specific cause wise treatment options to decrease the variceal bleed and hepatic decompensation. Based on extensive review of literature, management from pre-conceptional period to postpartum is outlined in order to have optimal maternal and perinatal outcomes. ( J CLIN EXP HEPATOL 2014;4:163-171) P regnancy associated with liver diseases is an infrequent situation, but when seen together, presents a complicated clinical situation. Portal hypertension develops as a result of number of etiologies. In the west, cirrhosis is the commonest cause of portal hypertension. In the setting of cirrhotic portal hypertension, pregnancy is very rare due to hepatocellular damage leading to amenorrhea and infertility, the incidence of cirrhosis in pregnancy has been reported as 1 in 5950 pregnancies. 1 Cirrhosis may get exacerbated during pregnancy and has significant adverse effects on the mother and the baby. [2][3][4] In the developing countries, other causes like extrahepatic portal vein obstruction contribute significantly to noncirrhotic portal hypertension (NCPH). Mostly liver function is much better preserved in women with NCPH and pregnancy is spontaneous in these women. Portal hypertension associated with pregnancy is a high risk situation as both pregnancy and portal hypertension share some of the hemodynamic changes. The physiological changes, in adaptation to the pregnancy and fetal needs, worsen the portal hypertension resulting in potentially life-threatening variceal bleed and other complications. Pregnancy is a potential hazard for occurrence of recurrent variceal bleed due to its hyperdynamic state causing increase in flow to the collaterals. 5-7 Therefore management in pregnancy requires knowledge of both the effects of changes during pregnancy on portal hemodynamics and the effects of portal hypertension and its cause on both mother and fetus, hepatotoxic...

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Section: Splenic Artery Aneurysm Rupturementioning

confidence: 99%

Pregnancy with Portal Hypertension

Aggarwal

Negi

Aggarwal

et al. 2014

Journal of Clinical and Experimental Hepatology

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“…In 25% of the cases, a double rupture phenomenon has been described with the initial hemorrhage being controlled by tamponade mediated by clot formation in the lesser sac followed by further clinical deterioration after the first event as blood flows into the greater intraperitoneal sac. 1,14,15 Emergent splenectomy remains the most common form of surgical therapy for SAA rupture. 17 Hypotension secondary to acute blood loss is treated in the usual manner with crystalloid and blood product administration until definitive surgical repair is undertaken.…”

Section: Discussionmentioning

confidence: 99%

Ruptured Splenic Artery Aneurysm in Pregnancy: a Case Series

Garey

Greenberger

Werman

2014

Air Medical Journal

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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%

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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Rupture of splenic artery aneurysm in a pregnant patient with portal hypertension

Cited by 48 publications

References 2 publications

Pregnancy with Portal Hypertension

Pregnancy with Portal Hypertension

Ruptured Splenic Artery Aneurysm in Pregnancy: a Case Series

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

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