2388 Multidisciplinary management of pregnancy with ruptured splenic artery aneurysm in a DGH

Published Date: 09th June 2021

Publication Authors: Mathur P, Jones F, D'Costa D, Srivastava N, Idama TO

Objective
We report a case of ruptured splenic artery aneurysm in pregnancy which is a rare clinical entity often missed antenatally and diagnosed on laparotomy for other suspected causes of intraabdominal haemorrhage. This case highlights the importance of maintaining a high index of suspicion and multidisciplinary approach to achieve good outcome

Case Report
We report the case of 31 year old Caucasian female Gravida 2 Para 1 at 34 weeks gestation who presented with acute abdomen. A 3 cm splenic artery ruptured aneurysm was diagnosed on CT scan with extensive retroperitoneal haematoma. Interestingly this patient had pulmonary embolism in last pregnancy and on retrospective review of CTPA there was an identifiable splenic artery aneurysm. Patient was managed with Multidisciplinary team approach and underwent Laparotomy with caesarean section with drainage of haematoma with splenectomy with total blood loss of 4 litres. Mum and baby made good recovery with Mum being discharged on day 6.

In our unit another case of ruptured splenic artery aneurysm in pregnancy was managed in 2008 with good maternal outcome and unfortunately a stillborn fetus. This highlights the improvement in management strategies and clinical practice over years with early involvement with other specialities to improve outcomes in such complex cases with diagnostic and treatment dilemmas.

Discussion
Ruptured SAA in pregnancy is a rare diagnosis usually diagnosed late with adverse maternal and fetal outcomes. Although further research is needed to clarify management strategy for women with unruptured SAA, ruptured SAA's need to be managed proactively with arrest of bleeding being the main priority to achieve good maternal and fetal outcome.

Conclusion
High index of suspicion and multidisciplinary approach helped to achieve good maternal and fetal outcome in this case. Minimally invasive operative techniques and interventional radiology should be considered in stable patients depending on availability and clinical status.

 

Mathur, P; Jones, F; D'Costa, D; Srivastava, N; Idama, T. (2021). Multidisciplinary management of pregnancy with ruptured splenic artery aneurysm in a DGH. BJOG: An International Journal of Obstetrics and Gynaecology. 128 (s2), 107.

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