Rupture of Splenic Artery Aneurysm after Cesarean Delivery

Shin, Y W; Cha, S H; Shin, M C; Kim, C W; Jung, J S; Chee, Y H

Abstract

Ruptured splenic artery aneurysm during pregnancy or delivery is very rare and it carries an exceedingly high mortality. The majority of splenic artery aneurysm ruptures during pregnancy occur in the third trimester. The literature reports a 25% mortality rate for ruptured splenic artery aneurysm. The mortality rate among pregnant women is high at 75% with a fetal mortality rate of 95%. The features of ruptured splenic artery aneurysm often include left flank or abdominal pain with radiation to the left shoulder, subsequently followed by severe left upper quadrant pain and shock. A double-rupture phenomenon may provide temporary tamponade with resolution of symptoms. A diagnosis of ruptured splenic artery aneurysm should be considered in any pregnant patient who complains of the sudden onset of severe left upper abdominal pain regardless of whether pain or shock is prominent at the time of evaluation. Maternal and fetal survival depends upon physician`s awareness of the possibility of splenic artery aneurysm rupture during pregnancy or postpartum, prompt recognition of the signs and symptoms of the condition, and immediate surgery to arrest hemorrhage. We have experienced one case of ruptured splenic artery aneurysm after cesarean delivery and reported with review of the literature.