Splenic artery aneurysm rupture in pregnancy

Abstract 

Splenic artery aneurysm (SAA) is the commonest visceral artery aneurysm. It is diagnosed more frequently in younger women, with up to 95% presenting during pregnancy. Rupture is associated with a disproportionately high maternal and fetal mortality.

We performed a literature search on the patient and SAA characteristics, clinical presentations, management and outcome of this serious complication.

There were 32 patients in total with a mean age of 27.9 years (range 20–38). The mean SAA size was 2.25cm (range 0.5–4cm) and from the available data half of the ruptured SAA were 2cm or less. Only one case (3.1%) was discovered incidentally, whilst the rest (96.9%) were found following rupture. The majority ruptured spontaneously. Most (62%) of the patients underwent SAA ligation and splenectomy. The maternal death rate was 21.9% (n=7), and fetal death rate was 15.6% (n=5).

Most cases are not diagnosed until surgery following rupture. Ruptured SAA should be considered in the differential diagnosis of a pregnant patient with severe and unexplained abdominal pain.

Keywords: Splenic artery aneurysm, Rupture, Pregnancy, Survival, Management, Subsequent pregnancy