Case Report of Rupture of Splenic Artery Aneurysm during Pregnancy with Poor Outcomes
Raymond Anchan *
Department of Obstetrics and Gynecology, Brody School of Medicine of East Carolina University Greenville, North Carolina 27834, USA and Division of Reproductive Endocrinology and Infertility, Center for Infertility and Reproductive Surgery, Department of Obstetrics and Gynecology Brigham and Women’s Hospital Harvard Medical School Boston, Massachusetts 02115, USA.
Anju Sinha
Department of Obstetrics and Gynecology, Brody School of Medicine of East Carolina University Greenville, North Carolina 27834, USA.
Assia Stepanian
Department of Obstetrics and Gynecology, Brody School of Medicine of East Carolina University Greenville, North Carolina 27834, USA.
Jennifer S. Lindsey
Division of Reproductive Endocrinology and Infertility, Center for Infertility and Reproductive Surgery, Department of Obstetrics and Gynecology Brigham and Women’s Hospital Harvard Medical School Boston, Massachusetts 02115, USA.
Keith H. Nelson
Department of Obstetrics and Gynecology, Brody School of Medicine of East Carolina University Greenville, North Carolina 27834, USA.
Raymond A. Dombroski
Department of Obstetrics and Gynecology, Brody School of Medicine of East Carolina University Greenville, North Carolina 27834, USA.
*Author to whom correspondence should be addressed.
Abstract
Aims: To highlight the importance of considering non-obstetrical etiologies for acute abdominal pain in gravid patients with risk factors for vasculopathies including diabetes and hypertension. Specifically, we report a tragic case of splenic artery aneurysm (SAA) rupture during the third trimester in a diabetic patient resulting in maternal-fetal mortality. Traumatic vascular events during pregnancy may be associated with a high rate of maternal and fetal morbidity or mortality. Therefore early and rapid intervention is critical to the obstetrical outcome.
Presentation of Case: A 35 year old multiparous hypertensive diabetic patient presented with acute abdominal pain at 33 weeks of gestation. The presumptive diagnosis was concealed placental abruption with diabetic ketoacidosis. Although non-obstetrical diagnoses were not initially considered, postmortem analysis revealed a non-obstetrical etiology of SAA rupture with catastrophic consequences for the patient and fetus.
Discussion: The likelihood of aneurysm rupture of SAA is heightened due to vasculopathic medical comorbidities such as hypertension and diabetes. The vascular congestion of pregnancy increases flow through arteries, leading to increased likelihood of aneurysm rupture without warning or preceding symptoms. Preconception screening and imaging modalities to confirm splenic artery aneurysms and elective repair are also discussed. Early consideration and accurate identification of SAA rupture is critical to saving the lives of both mother and fetus.
Conclusion: SAA rupture, in the differential diagnosis of acute abdominal pain in pregnancy, should be considered more likely in multiparous patients and in the presence of comorbidities such as diabetes and hypertension.
Keywords: Splenic artery aneurysm rupture, diabetes, hypertension, pregnancy