Spontaneous Rupture of Splenic Artery Aneurysm during the First Trimester of Pregnancy: Report of an Extremely Rare Case and Review of the Literature

Abstract

Splenic artery aneurysm (SAA) occurs predominantly in women and the majority of them are asymptomatic until rupture. In cases of spontaneous rupture of an SAA, maternal and fetal mortality rates remain extremely high. Furthermore, the spontaneous ruptures of SAAs predominantly appear during the third trimester of pregnancy. We present the third known case of spontaneous SAA rupture during the first trimester of pregnancy, which manifested as sudden hypovolemic collapse and was successfully confronted with combined aggressive resuscitation and emergency surgical operation.

An Exceptionally Rare Cause of Upper Digestive Tract Hemorrhage: the Intragastric Rupture of a Splenic Artery Aneurysm Associated with a Pancreatic Adenocarcinoma

“…The main causes for severe UDTHs remain gastroduodenal ulcers and esophageal varices in the context of portal hypertension [ 1 ]. In rarer cases, massive deglobulinization is due to an aortoduodenal fistula, to the rupture of a hemorrhagic pancreatic pseudocyst in the gastric or duodenal lumen, or to the intragastric rupture of an SAA as reported here [ 2 3 4 5 6 7 8 ]. Massive UDTHs, whose mortality rate is about 10 percent, benefit essentially from endoscopic treatment [ 1 ].…”

“…The true aneurysm is the result, among others, of lesions of the elastic tissue and of the smooth muscle cells of the artery wall, lesions which are enhanced by atherosclerosis, arterial hypertension, portal hypertension, fibro-muscular dysplasia, and an increase of estroprogestative hormone levels [ 2 5 8 ]. This latter factor explains the frequency of SAAs and their increased fragility in pregnant women [ 7 ].…”

“…SAA rupture in general happens in one or two stages with, in the latter case, a hemorrhage which is first limited to the omental bursa and then extends to the whole peritoneal cavity [ 7 8 ]. SAAs derive great benefit from contrast-enhanced CT since they are deeply located and poorly detected by echography.…”

Ruptured Splenic Artery Aneurysm in Pregnancy: a Case Series

“…3,4,6,7 At least 3 cases of SAA have been reported to occur as early as the first trimester of pregnancy. 8,9 Because of the infrequency of SAA complicating pregnancy, there is a relative paucity of literature about this condition. To our knowledge, this is the first time SAA rupture in pregnant patients has been reported in the critical care transport literature.…”

“…10 Even then, the diagnosis of severe abdominal pain and hypotension in pregnancy may be attributed to a variety of potential working diagnoses such as ruptured ectopic pregnancy, placental abruption, uterine rupture, amniotic fluid embolism, pulmonary thromboembolism, cholecystitis, appendicitis, or perforation of a peptic ulcer. [7][8][9]12 The use of ultrasound to detect free fluid may help with early, and often lifesaving, diagnosis of hemoperitoneum in a stable pregnant patient presenting with abdominal pain. The mortality from a ruptured SAA has been reported to be as high as 36% to 40% in the general population and up to 70% for pregnant women specifically, with mortality for the fetus upward of 90%.…”