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Case Reports: Reminder of important clinical lesson
Splenic artery aneurysm rupture in pregnancy: challenges in diagnosis and the importance of multidisciplinary management
  1. Emily Vaughan1,2,
  2. Tarryn Carlsson3,
  3. Marcus Brooks4 and
  4. Mohamed Elhodaiby1,5
  1. 1University of Bristol, Bristol, UK
  2. 2Obstetrics and Gynaecology, Southmead Hospital, North Bristol Trust, Bristol, UK
  3. 3Interventional Radiology, Southmead Hospital, North Bristol Trust, Bristol, UK
  4. 4Vascular Surgery, Southmead Hospital, North Bristol Trust, Bristol, UK
  5. 5Obstetrics and Gynaecology, North Bristol Trust, Westbury on Trym, UK
  1. Correspondence to Dr Emily Vaughan; emily.vaughan{at}bristol.ac.uk

Abstract

This case of acute rupture of a splenic artery aneurysm in a patient 35 weeks pregnant demonstrates the difficulties in diagnosis and importance of multidisciplinary team management for surgical emergencies in pregnancy. A women in her early 30s presented at 35 weeks pregnant with sudden onset of severe epigastric pain and shortness of breath and was found to be tachycardic with a raised lactate. Differentials included a possible vascular event or pulmonary embolism. A CT scan demonstrated free fluid and likely ruptured splenic artery aneurysm. A rapid, thorough preoperative meeting enabled us to integrate multidisciplinary care effectively. She underwent coiling of her splenic artery, which was essential to reduce further intraoperative blood loss, followed by a midline incision for caesarean section of her baby and splenectomy. She had a long stay in the intensive care unit (ITU) and complex postoperative course but was discharged after 2 months to be reunited with her baby who was in good condition.

  • Interventional radiology
  • Pregnancy
  • Vascular surgery

https://doi.org/10.1136/bcr-2022-249227

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    Footnotes

    • Contributors EV designed, wrote and edited the manuscript. ME designed and edited the manuscript. TC provided the images and edited the manuscript. MB edited the manuscript.

    • Funding This study was funded by National Institute for Health Research (academic clinical fellowship for EV is an academic clinical fellow funded by NIHR).

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.