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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 2.25 cm (range 0.5–4 cm) and from the available data half of the ruptured SAA were 2 cm 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

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      References

        • Lang W.
        • Strobel D.
        • Beinder E.
        • Raab M.
        Surgery of a splenic artery aneurysm during pregnancy.
        European Journal of Obstetrics & Gynecology & Reproductive Biology. 2002; 102: 215-216
        • Holdsworth R.
        • Gunn A.
        Ruptured splenic artery aneurysm in pregnancy. A review.
        British Journal of Obstetrics and Gynecology. 1992; (00): 595-597
        • Jack S.
        • Hammond R.
        • James D.
        Diagnosis and treatment of ruptured splenic artery aneurysm in pregnancy.
        Journal of Obstetrics & Gynecology. 1997; 18: 86-87
        • Sele-Ojeme D.
        • Welch C.
        Review: spontaneous rupture of splenic artery aneurysm in pregnancy.
        European Journal of Obstetrics & Gynaecology & Reproductive Biology. 2003; 109: 124-127
        • Di Vella G.
        • Arpaio A.
        • Marzullo A.
        • Colonna M.
        Rupture of the spleen or splenic vessels (splenic emergency syndrome) in late pregnancy: a report of two autopsy cases.
        Forensic Science International. 2008; 176: e1-e5
        • Hunsaker D.
        • Turner S.
        • Hunsaker J.
        Sudden and unexpected death resulting from splenic artery aneurysm rupture.
        The American Journal of Forensic Medicine and Pathology. 2002; 23: 338-341
        • McNeely R.
        • Anderle L.
        • Conklin C.
        Splenic artery aneurysm rupture in pregnancy with maternal and fetal survival.
        The Journal of Reproductive Medicine. 1992; 37: 939-942
        • Trastek V.
        • Pairolero P.
        • Joyce J.
        • Hollier L.
        • Bernatz P.
        Splenic artery aneurysms.
        Surgery. 1982; 91: 694-699
        • Ting I.
        A case of splenic arterio-venous aneurysm.
        The Australian and New Zealand Journal of Surgery. 1968; 37: 236-239
        • Angelakis E.
        • Bair W.
        • Barone J.
        • Lincer R.
        Splenic artery aneurysm rupture during pregnancy.
        Obstetrical & Gynecological Survey. 1993; 48: 145-148
        • Sadat U.
        • Dar O.
        • WAlsh S.
        • Varty K.
        Splenic artery aneurysms in pregnancy—a systematic review.
        International Journal of Surgery. 2008; 6: 261-265
        • Wadsworth R.
        • Devine A.
        • Raychaudhuri K.
        Splenic artery aneurysm rupture as a cause of maternal collapse.
        International Journal of Obstetric Anaesthesia. 1996; 5: 99-102
        • Cressey D.
        • Reid M.
        Splenic artery aneurysm rupture in pregnancy.
        International Journal of Obstetric Anesthesia. 1996; 5: 103-104
        • Jotkowitz M.
        • Polglase A.
        Splenic artery aneurysm in pregnancy.
        Australia and New Zealand Journal of Obstetrics and Gynaecology. 1995; 35: 232-233
        • Algwiser A.
        Rupture of splenic artery aneurysm during pregnancy: three case reports with a review of the literature.
        Annals of Saudi Medicine. 1991; 11: 221-225
        • Lowry S.
        • O’Dea T.
        • Gallagher D.
        • Mozenter R.
        Splenic artery aneurysm rupture: the seventh instance of maternal and fetal survival.
        Obstetrics and Gynecology. 1986; 67: 291-292
        • MacFarlene J.
        • Thorbjarnarson B.
        Rupture of splenic artery aneurysm during pregnancy.
        American Journal of Obstetrics and Gynaecology. 1966; 95: 1025-1037
        • de Perrot M.
        • Buhler L.
        • Schneider P.
        • Mentha G.
        • Morel P.
        Do aneurysms and pseudoaneurysms of the splenic artery require different surgical strategy.
        Hepato_Gastroenterology. 1999; 46: 2028-2032
        • Herbeck M.
        • Horbach T.
        • Putzenlechner C.
        • Klein P.
        • Lang W.
        Ruptured splenic artery aneurysm during pregnancy: a rare case with both maternal and fetal survival.
        American Journal of Obstetrics and Gynecology. 1999; 181: 763-764
        • Vassalotti S.
        • Schaller J.
        Spontaneous rupture of splenic artery aneurysm in pregnancy.
        Obstetrics and Gynecology. 1967; 30: 264-268
        • Popham P.
        • Buettner A.
        Arterial aneurysms of the lienorenal axis during pregnancy.
        International Journal of Obstetric Anesthesia. 2003; 12: 117-119
        • Pollak E.
        • Michas C.
        Massive spontaneous hemoperitoneum due to rupture of visceral branches of the abdominal aorta.
        American Surgeon. 1979; 45: 621-630
        • Stanley J.
        • Wakefield T.
        • Graham L.
        • Whitehouse W.
        • Zelenock G.
        • Lindenauer S.
        Clinical importance and management of splanchnic artery aneurysms.
        Journal of Vascular Surgery. 1986; 3: 836-840
        • de Vries J.
        • Schattenkerk M.
        • Malt R.
        Complications of splenic artery aneurysm other than intraperitoneal rupture.
        Surgery. 1982; 91: 200-204
        • Joske R.
        Occurrence of large proximal splenic artery aneurysms in chronic liver disease.
        Australia and New Zealand Journal of Medicine. 1978; 8: 515-517
        • O’Grady J.
        • Day E.
        • Toole A.
        • Paust J.
        Splenic artery aneurysm rupture in pregnancy.
        Obstetrics and Gynecology. 1977; 50: 627-630
        • Sener E.
        • Gok U.
        • Kocamanoglu S.
        Postpartum cardiopulmonary arrest due to spontaneous rupture of splenic artery aneurysm after caesarean section.
        Journal of Clinical Anesthesia. 2006; 18: 242-243
        • Mehrotra D.
        • diBenedetto R.
        • Theriot E.
        • Mehta P.
        Spontaneous rupture of splenic artery aneurysm: sixth instance of both maternal and fetal survival.
        Obstetrics and Gynecology. 1983; 62: 665-666
        • Caillouette J.
        • Merchant E.
        Ruptured splenic artery aneurysm in pregnancy: twelfth reported case with maternal and fetal survival.
        American Journal of Obstetrics and Gynecology. 1993; 168: 1810-1813
        • Bettendorf O.
        • Falbrede J.
        • Eltze E.
        • Bocker W.
        Ruptured splenic artery aneurysm during pregnancy with maternal death and premature infant survival.
        European Journal of Obstetrics & Gynecology & Reproductive Biology. 2004; 117: 119-120
        • Selo-ojeme D.
        • Robarts P.
        Spontaneous rupture of splenic artery aneurysm in pregnancy.
        Journal of Obstetrics & Gynecology. 2004; 24: 460-461
        • Mahmood T.
        Spontaneous rupture of a splenic artery aneurysm in association with ectopic pregnancy.
        Journal of Obstetrics & Gynecology. 1988; 8: 264-265
        • Hayde S.
        • Gillett W.
        • Thompson I.
        Rupture of a splenic artery aneurysm in pregnancy.
        Australia and New Zealand Journal of Obstetrics and Gynaecology. 1990; : 30
        • Dunlop W.
        • Iwanicki S.
        • Akierman A.
        • Pasieka J.
        • Higgin J.
        Spontaneous rupture of splenic artery aneurysm: maternal and fetal survival.
        Canadian Journal of Surgery. 1990; 33: 407-408
        • Brass P.
        Splenic artery rupture in pregnancy: a case report.
        American Journal of Obstetrics and Gynecology. 1977; 128: 228-229
        • El-Shawarby S.
        • Franklin O.
        • South M.
        • Goodman J.
        Caesarean splenectomy for spontaneous rupture of splenic artery aneurysm at 34 weeks gestation with survival of the mother and the preterm fetus.
        Journal of Obstetrics & Gynecology. 2006; 26: 468-469
        • Bolaji I.
        • Vunnamadala S.
        • Hurlow R.
        • Blunt A.
        Splenic artery aneurysm rupture in pregnancy: “Double rupture” phenomenon.
        Journal of Obstetrics & Gynecology. 1988; 9: 130-131
        • Busutil R.
        • Brin B.
        The diagnosis and management of visceral artery aneurysms.
        Surgery. 1980; 88: 619-624
        • Fender G.
        • Haslett E.
        • Hackett G.
        Diagnosis and treatment of ruptured splenic artery aneurysm in pregnancy.
        Journal of Obstetrics & Gynecology. 1998; 18: 603
        • Czekelius P.
        • Deichert L.
        • Gesenhues T.
        • Schulz K.
        Rupture of an aneurysm of the splenic artery and pregnancy: a case report.
        European Journal of Obstetrics, Gynecology and Reproductive Biology. 1991; 38: 229-232