Splenic artery aneurysm rupture during pregnancy: A case report of maternal and fetal survival

Fujii, Manato; Yamashita, Satoshi; Fudono, Ayako; Yanai, Shuichi; Tashiro, Jun; Takenaka, Yasuhiro; Yamasaki, Kazuki; Ito, Eisaku; Masaki, Yukiyoshi

doi:10.1016/j.ijscr.2020.09.173

Cited by 3 publications

(2 citation statements)

References 21 publications

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“…Previous published case reports and a systematic review of splenic artery aneurysm demonstrate that most frequently, a presentation of severe abdominal pain in pregnancy is presumed by obstetricians to be uterine abruption and intraoperative diagnosis of free intraperitoneal blood and possible splenic artery aneurysm is only made intraoperatively 1–4 7. Intraoperative diagnosis of a large vascular bleed rather than preoperative means that teams have less time to ensure appropriate planning and staffing for this surgical emergency, likely reducing quality of care for patients.…”

Section: Discussionmentioning

confidence: 99%

“…Ruptured splenic artery aneurysm is associated with a 75% maternal mortality rate and up to 95% fetal mortality rate in the published works; therefore, a low index of suspicion is required to manage these rare cases with high mortality rates 2. A review of the literature and case reports shows the propensity for obstetric doctors to assume placental abruption and only to be faced with haemoperitoneum on laparotomy and later diagnosis of splenic artery aneurysm rupture 2–4. Intraoperative diagnosis of a ruptured splenic artery does not allow for preoperative multidisciplinary team (MDT) planning for such complex surgical cases to optimise outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Splenic artery aneurysm rupture in pregnancy: challenges in diagnosis and the importance of multidisciplinary management

et al. 2022

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This case of acute rupture of a splenic artery aneurysm in a patient 35 weeks pregnant demonstrates the difficulties in diagnosis and importance of multidisciplinary team management for surgical emergencies in pregnancy. A women in her early 30s presented at 35 weeks pregnant with sudden onset of severe epigastric pain and shortness of breath and was found to be tachycardic with a raised lactate. Differentials included a possible vascular event or pulmonary embolism. A CT scan demonstrated free fluid and likely ruptured splenic artery aneurysm. A rapid, thorough preoperative meeting enabled us to integrate multidisciplinary care effectively. She underwent coiling of her splenic artery, which was essential to reduce further intraoperative blood loss, followed by a midline incision for caesarean section of her baby and splenectomy. She had a long stay in the intensive care unit (ITU) and complex postoperative course but was discharged after 2 months to be reunited with her baby who was in good condition.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Splenic artery aneurysm rupture in pregnancy: challenges in diagnosis and the importance of multidisciplinary management

et al. 2022

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Endovascular and Open Surgical Treatment of Ruptured Splenic Artery Aneurysms: A Case Report and a Systematic Literature Review

Rinaldi,

Brioschi,

Marone

2023

JCM

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Background: Ruptured splenic artery aneurysms (r-SAA), although rare, are burdened by high morbidity and mortality, even despite emergent surgical repair. It is suggested that endovascular treatment can achieve reduction in peri-operative death and complication rates, as in other vascular diseases, but evidence of such benefits is still lacking in this particular setting. We report a case of an r-SAA treated by trans-arterial embolization and then converted to open surgery for persistent bleeding, and we provide a systematic review of current results of open and endovascular repair of r-SAAs. Materials and Methods: A 50-year-old male presenting in shock for a giant r-SAA underwent emergent coil embolization and recovered hemodynamic stability. On the following day, he underwent laparotomy for evacuation of the huge intraperitoneal hematoma, but residual bleeding was noted from the splenic artery, which was ligated after coil removal, and a splenectomy was performed. A systematic literature review of the reported mortality and complications of r-SAA undergoing open (OSR) or endovascular (EVT) treatment was performed using the main search databases. All primary examples of research published since 1990 were included regardless of sample size. The main outcome measures were mortality and reinterventions. Secondary outcomes were post-operative complications. Results: We selected 129 studies reporting on 350 patients—185 treated with OSR and 165 with EVT. Hemodynamically unstable patients and ruptures during pregnancy were more frequently treated with open repair. Overall, there were 37 deaths (mortality: 10.6%)—24 in the OSR group and 13 in the EVTr group (mortality: 12.9% and 7.8% respectively, p-value: 0.84). There were 37 reinterventions after failed or complicated endovascular repair —6 treated with endovascular re-embolization and 31 with laparotomy and splenectomy (22.4%); there were 3 (1.6%) reinterventions after open repair. Overall complication rates were 7.3% in the EVT group (n: 12) and 4.2% in the OSR group (n: 7), and did not require reintervention. No significant differences in overall complications or in any specific complication rate were observed between the two groups. Conclusions: Current results of r-SAA treatment show equipoise terms of morbidity and mortality between open and endovascular repair; however, in case of hemodynamic instability and rupture during pregnancy, open surgery might still be safer. Moreover, endovascular repair is still burdened by a significantly higher rate of reinterventions, mostly with conversions to open surgery.

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A Splenic Rupture Following a Singleton Spontaneous Vaginal Delivery: The First-Known Case Report in Saudi Arabia

Ahmed,

Yaseen,

Aljudaibi

et al. 2024

Cureus

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A spontaneous rupture of the spleen during pregnancy or post-delivery is an exceptionally rare but potentially fatal maternal complication that poses a significant challenge in diagnosis and management. Herewith, we present a case of a 31-year-old female patient who experienced a spontaneous splenic rupture following a singleton vaginal delivery. Despite lacking any history of trauma or a predisposing factor, she developed symptoms of dizziness and postpartum abdominal pain, progressing rapidly to unconsciousness. Urgent abdominal ultrasound revealed significant intraperitoneal bleeding with a large peri-splenic hematoma, necessitating emergency exploratory laparotomy. Histopathological examination of a frozen section ruled out malignancy, and thus, a complete splenectomy was done, which confirmed the diagnosis of spontaneous splenic rupture. This case emphasizes the importance of close monitoring of all postpartum women, even those with low-risk pregnancies, for the early detection of any complication. Healthcare providers should maintain a high index of suspicion for rare but potentially life-threatening events to ensure timely intervention and optimal outcomes.

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Splenic artery aneurysm rupture during pregnancy: A case report of maternal and fetal survival

Abstract: Highlights Delayed diagnosis of SAA rupture during pregnancy occurred. Maternal and fetal survival following SAA rupture during pregnancy was achieved. Multidisciplinary efforts were relevant on treatments for SAA rupture in pregnancy.

Cited by 3 publications

References 21 publications

Splenic artery aneurysm rupture in pregnancy: challenges in diagnosis and the importance of multidisciplinary management

Splenic artery aneurysm rupture in pregnancy: challenges in diagnosis and the importance of multidisciplinary management

Endovascular and Open Surgical Treatment of Ruptured Splenic Artery Aneurysms: A Case Report and a Systematic Literature Review

A Splenic Rupture Following a Singleton Spontaneous Vaginal Delivery: The First-Known Case Report in Saudi Arabia

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