Rupture of Splenic Artery Aneurysm With Portal Hypertension During Pregnancy: A Case Report

Background: Spontaneous rupture of a splenic artery aneurysm (SAA) during pregnancy is a rare event with catastrophic consequences. This report presents a case of SAA associated with portal hypertension that ruptured during pregnancy with maternal survival. Case: A 27-year-old primigravid woman at 31 weeks of gestation presented to the Emergency Department at Pars Hospital in Tehran, Iran with sudden onset of severe abdominal pain. She was in obvious distress with blood pressure of 90/50 mm Hg and a pulse rate of 110 beats per minute. Abdominal ultrasound confirmed free fluid in the peritoneal cavity. The patient was immediately transferred to the operating room. An infant delivered by Caesarean section died shortly thereafter. There was no evidence of placental abruption, but about 2 L of blood was noted in the abdominal cavity. A ruptured SAA was found. Proximal ligation of the splenic artery was performed followed by splenectomy. The patient did well and was discharged on the eighth postoperative day. Conclusion: This case illustrates the need to consider ruptured SAA as part of differential diagnosis of hemoperitoneum in pregnant women. Immediate surgical intervention is needed to ensure survival of mother and fetus. © 2006 Society of Obstetricians and Gynaecologists of Canada