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Lee SH, Yang S, Park I, Im YC, Kim GY. Ruptured splenic artery aneurysms in pregnancy and usefulness of endovascular treatment in selective patients: A case report and review of literature. World J Clin Cases 2022; 10:9057-9063. [PMID: 36157677 PMCID: PMC9477030 DOI: 10.12998/wjcc.v10.i25.9057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/25/2022] [Accepted: 07/18/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The rupture of a splenic artery aneurysm (SAA) in pregnancy is an uncommon condition. However, it is associated with high mortality rates in pregnant women and fetuses even after surgical treatment. Though the endovascular treatment of SAAs is currently preferred as it can improve the outcomes even in emergent cases, the endovascular treatment of a ruptured SAA during pregnancy has not been reported until date.
CASE SUMMARY We report a case of a 33-year-old woman with the sudden onset of epigastric pain due to a ruptured SAA at the mid-portion of the splenic artery at 18 wk of pregnancy. After emergent initial resuscitation, the patient was diagnosed with a ruptured SAA through digital angiography. Immediately upon diagnosis, she underwent emergent endovascular embolization of the splenic artery for the rupture on the spot. Next, surgery was performed to remove the hematoma under stable conditions. Although the fetus was found to be dead during resuscitation, the woman recovered without complications and was discharged 15 d postoperatively.
CONCLUSION Endovascular treatment might be a valuable alternative to surgery/lead to safer surgery for selected pregnant patients with ruptured SAAs.
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Affiliation(s)
- Sang Hun Lee
- Department of Obstetrics and Gynecology, Ulsan University and Ulsan University Hospital, Ulsan 44033, South Korea
| | - Songsoo Yang
- Department of Surgery, Ulsan University and Ulsan University Hospital, Ulsan 44033, South Korea
| | - Inkyu Park
- Department of Surgery, Ulsan University and Ulsan University Hospital, Ulsan 44033, South Korea
| | - Yeong Cheol Im
- Department of Surgery, Ulsan University and Ulsan University Hospital, Ulsan 44033, South Korea
| | - Gyu Yeol Kim
- Department of Surgery, Ulsan University and Ulsan University Hospital, Ulsan 44033, South Korea
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Ornaghi S, Crippa I, Di Nicola S, Giardini V, La Milia L, Locatelli L, Corso R, Roncaglia N, Vergani P. Splenic artery aneurysm in obstetric patients: a series of four cases with different clinical presentation and outcome. Int J Gynaecol Obstet 2022; 159:474-479. [PMID: 35122689 DOI: 10.1002/ijgo.14133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 01/25/2022] [Accepted: 02/02/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To describe four consecutive cases of splenic artery aneurysm with different clinical patterns of presentation among obstetric patients. METHOD A series of four cases of splenic artery aneurysm diagnosed in pregnant or post-partum women at our University center between January 1998 and December 2020. Clinical and radiological data were retrospectively obtained by reviewing paper and electronic medical records after acquiring patient's consent. RESULTS One case was completely asymptomatic and incidentally identified at the beginning of pregnancy, thus allowing for multidisciplinary treatment. The other three cases were unknown: two manifested with maternal collapse due to aneurysm rupture in the third trimester of gestation, whereas one presented with acute abdominal pain during the post-partum period and was successfully managed before rupture occurred. CONCLUSION Although being extremely rare, SAA rupture in obstetric patients can be associated with dramatic consequences. Since early suspicion and prompt intervention are essential to avoid fatal outcomes, promotion of knowledge of all the potential clinical patterns of presentation of SAA rupture among obstetric patients is mandatory.
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Affiliation(s)
- Sara Ornaghi
- Department of Obstetrics, MBBM Foundation at San Gerardo Hospital, Monza, Italy
- University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
| | - Isabella Crippa
- Department of Obstetrics, MBBM Foundation at San Gerardo Hospital, Monza, Italy
| | - Sara Di Nicola
- Department of Obstetrics, MBBM Foundation at San Gerardo Hospital, Monza, Italy
- University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
| | - Valentina Giardini
- Department of Obstetrics, MBBM Foundation at San Gerardo Hospital, Monza, Italy
| | - Laura La Milia
- Department of Obstetrics, MBBM Foundation at San Gerardo Hospital, Monza, Italy
- University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
| | - Luca Locatelli
- Department of Obstetrics, MBBM Foundation at San Gerardo Hospital, Monza, Italy
- University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
| | - Rocco Corso
- Department of Radiology, San Gerardo Hospital, Monza, Italy
| | - Nadia Roncaglia
- Department of Obstetrics, MBBM Foundation at San Gerardo Hospital, Monza, Italy
| | - Patrizia Vergani
- Department of Obstetrics, MBBM Foundation at San Gerardo Hospital, Monza, Italy
- University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
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Anand A, Khurana S, Ateriya N, Sunil Kumar Sharma GA. Sudden death due to non-traumatic rupture of splenic artery aneurysm. Med Leg J 2021; 90:76-78. [PMID: 34259054 DOI: 10.1177/00258172211018339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Splenic artery aneurysm is a rare form of vascular pathology that carries a high risk of mortality once it gets ruptured. It has a prevalence of 1% and occurs due to thinning and dilatation of the arterial wall. CASE We describe a case of a 35-year-old policeman who died suddenly. At medico-legal autopsy, intraperitoneal clotted blood about 1000 g and liquid blood about 3000 ml were seen. On further exploration, ruptured splenic artery aneurysm about 2.0 cm in diameter became visible near the hilum. CONCLUSION Rare cases typically present as sudden and unexpected death with intraperitoneal bleed and may be confused with blunt trauma abdomen. Therefore, splenic artery aneurysm is an appropriate differential diagnosis for sudden deaths and intraperitoneal bleeding, respectively.
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Affiliation(s)
- Aditya Anand
- Department of Forensic Medicine, Vardhman Mahavir Medical College (VMMC) and Safdarjung Hospital, New Delhi, India
| | - Sahil Khurana
- Department of Forensic Medicine, Vardhman Mahavir Medical College (VMMC) and Safdarjung Hospital, New Delhi, India
| | - Navneet Ateriya
- Department of Forensic Medicine & Toxicology, All India Institute of Medical Sciences, Gorakhpur, India
| | - G A Sunil Kumar Sharma
- Department of Forensic Medicine, Vardhman Mahavir Medical College (VMMC) and Safdarjung Hospital, New Delhi, India
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Ikenaga S, Yunaiyama D, Saguchi T, Otaka J, Yamada T, Ito H, Sugimoto K, Itoi T, Saito K. A case of a patient who underwent transcatheter arterial embolization for unruptured splenic aneurysm during pregnancy. Radiol Case Rep 2020; 16:78-83. [PMID: 33193933 PMCID: PMC7644823 DOI: 10.1016/j.radcr.2020.10.054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 10/26/2020] [Accepted: 10/26/2020] [Indexed: 11/24/2022] Open
Abstract
Here, we report the case of a 30-year-old female patient who underwent coil embolization for unruptured splenic artery aneurysm without any complication at 26 weeks of pregnancy with reduction in fetal radiation exposure. The patient did not suffer from rupture of splenic artery aneurysm during or after procedure. Pregnancy is a risk factor of splenic artery aneurysm rupture with a high mortality rate. Transcatheter arterial embolization at 26 weeks of pregnancy might be a better treatment alternative for a pregnant patient with splenic artery aneurysm with respect to the endurance of fetal radiation exposure to prevent aneurysm rupture.
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Affiliation(s)
- Shoichi Ikenaga
- Department of Radiology, Tokyo Medical University, Address: 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023 Japan
| | - Daisuke Yunaiyama
- Department of Radiology, Tokyo Medical University, Address: 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023 Japan
| | - Toru Saguchi
- Department of Radiology, Tokyo Medical University, Address: 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023 Japan
| | - Jun Otaka
- Department of Radiology, Tokyo Medical University, Address: 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023 Japan
| | - Takafumi Yamada
- Department of Radiology, Tokyo Medical University, Address: 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023 Japan
| | - Hiroe Ito
- Department of Obstetrics and Gynecology, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Katsutoshi Sugimoto
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Kazuhiro Saito
- Department of Radiology, Tokyo Medical University, Address: 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023 Japan
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Management of a Splenic Artery Aneurysm in the Third Trimester of Pregnancy. Case Rep Obstet Gynecol 2020; 2020:8892605. [PMID: 33014487 PMCID: PMC7525319 DOI: 10.1155/2020/8892605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 07/29/2020] [Accepted: 09/10/2020] [Indexed: 11/26/2022] Open
Abstract
Background Splenic artery aneurysm (SAA) is a rare but potentially fatal complication associated with high maternal and fetal mortality when occurring during pregnancy. Case A 29-year-old G4P3003 at 34 4/7 weeks of gestation was admitted with left upper quadrant pain and newly diagnosed SAA in the hilum. She was scheduled for embolization of the SAA but the night before went into labor. A multidisciplinary team discussion was held, and the patient underwent successful primary low transverse c-section via Pfannenstiel skin incision followed by laparoscopic splenectomy under general anesthesia. She delivered a male newborn with birth weight of 2855 and Apgar score of 8/5. Summary and Conclusion. Early diagnosis and management of SAA are key for improved maternal and fetal outcomes. Our case demonstrates that through a multidisciplinary approach and anticipation of the possible clinical scenarios, good outcomes can be achieved.
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Abstract
True splenic artery aneurysms (SAA) are a rare, but potentially fatal, pathology. They are the third most common type of abdominal aneurysm, after aneurysms of the aorta and of the iliac artery, and account for almost the all aneurysms of visceral arteries. True aneurysms account for 60% of SAA and affect four times as many women as men, generally related to increased incidental or symptomatic findings that coincide with use of ultrasonography in pregnancy. Among pregnant patients, mortality after rupture is 65-75%, with fetal mortality exceeding 90%. There are multiple etiologies and it is believed that hormonal influences and changes in portal flow during gestation play an important role in development of SAA. This review discusses their history, epidemiology, pathophysiology, and diagnosis and current treatment techniques.
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Ballout RA, Ghanem R, Nassar A, Hallal AH, Ghulmiyyah LM. Splenic Artery Aneurysm (SAA) Rupture in Pregnancy: A Case Report of a Rare but Life-Threatening Obstetrical Complication. JOURNAL OF WOMEN'S HEALTH AND DEVELOPMENT 2019; 2:19-27. [PMID: 31432025 PMCID: PMC6701845 DOI: 10.26502/fjwhd.2644-2884004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
This is the case of a 38 year-old Lebanese woman G2P1, history of previous cesarean section, presenting at 30+5 weeks of gestation with acute left-sided flank pain and a two-day history of chills and dysuria. In light of the clinical presentation, the patient was initially diagnosed with pyelonephritis and managed accordingly; however, her clinical status deteriorated with worsening hypotension and lethargy despite resuscitative measures and a normal abdominal ultrasound. Failure to revive the patient eventually led to a cardiac arrest for which a peri-mortem cesarean section was performed at bedside. Upon abdominal entry, an actively-bleeding ruptured splenic artery aneurysm (SAA) was identified, for which massive transfusion protocol was activated, and the patient was transferred to the operating room. The patient had a complicated postoperative course, the fetus was stillborn, and she was discharged home after 6 months of hospital stay. In view of the high mortality and morbidity associated with ruptured SAA in pregnancy, early recognition and prompt intervention are crucial for maternal and fetal benefit.
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Affiliation(s)
- Rami A Ballout
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Rayan Ghanem
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Anwar Nassar
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali H Hallal
- Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Labib M Ghulmiyyah
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
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Morton A. Splenic artery aneurysms, portal hypertension and pregnancy. J Hepatol 2019; 70:1025-1026. [PMID: 30733003 DOI: 10.1016/j.jhep.2018.12.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 12/13/2018] [Accepted: 12/17/2018] [Indexed: 02/08/2023]
Affiliation(s)
- Adam Morton
- Department of Obstetric Medicine, Mater Health, Australia.
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Wiener Y, Tomashev R, Neeman O, Itzhakov Z, Heldenberg E, Melcer Y, Maymon R. Splenic artery aneurysms during pregnancy: An obstetric nightmare. Eur J Obstet Gynecol Reprod Biol 2019; 237:121-125. [PMID: 31035119 DOI: 10.1016/j.ejogrb.2019.04.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 03/11/2019] [Accepted: 04/18/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVE In this study we report our experience in the management of Splenic Artery Aneurysm (SAA), diagnosed during pregnancy. STUDY DESIGN The current manuscript describes three different events, treated in out our department, involving SAAs diagnosed during pregnancy. Each case presents an unusual course and a unique clinical challenge. RESULTS The first case is of a 25 week's gestation twin pregnancy with ruptured SAA ending in maternal and fetal death. Another case of SAA rupture presented at 27 week's gestation with consequent emergency cesarean section and splenectomy. In the last case, two SAAs were incidentally diagnosed at 25 weeks' singleton gestation. The patient was managed conservatively and delivered by an elective cesarean section at 34 weeks followed by postpartum angiographic embolization of the aneurysms. CONCLUSIONS Health care providers and especially obstetricians should be aware of the diagnosis of ruptured SAA in a pregnant woman with abdominal discomfort and hemodynamic deterioration. In addition, once an asymptomatic pregnant patient is diagnosed with a SAA, conservative surveillance may be allowed.
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Affiliation(s)
- Yifat Wiener
- Departments of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center (formerly Assaf Harofeh Medical Center), Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Zerifin, 70300, Israel.
| | - Roni Tomashev
- Departments of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center (formerly Assaf Harofeh Medical Center), Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Zerifin, 70300, Israel
| | - Ortal Neeman
- Departments of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center (formerly Assaf Harofeh Medical Center), Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Zerifin, 70300, Israel
| | - Zalman Itzhakov
- Department of Interventional Radiology, The Yitzhak Shamir Medical Center (formerly Assaf Harofeh Medical Center), Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Zerifin, 70300, Israel
| | - Eitan Heldenberg
- Department of Vascular Surgery, The Yitzhak Shamir Medical Center (formerly Assaf Harofeh Medical Center), Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Zerifin, 70300, Israel
| | - Yaakov Melcer
- Departments of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center (formerly Assaf Harofeh Medical Center), Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Zerifin, 70300, Israel
| | - Ron Maymon
- Departments of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center (formerly Assaf Harofeh Medical Center), Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Zerifin, 70300, Israel
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Tannoury J, Honein K, Abboud B. Splenic artery aneurysm presenting as a submucosal gastric lesion: A case report. World J Gastrointest Endosc 2016; 8:496-500. [PMID: 27499832 PMCID: PMC4959943 DOI: 10.4253/wjge.v8.i14.496] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 05/23/2016] [Accepted: 06/16/2016] [Indexed: 02/05/2023] Open
Abstract
We are reporting the rare case of splenic artery aneurysm of 4 cm of diameter presenting as a sub mucosal lesion on gastro-duodenal endoscopy. This aneurysm was treated by endovascular coil embolization and stent graft implantation. The procedure was uneventful. On day 1, the patient presented an acute severe epigastric pain and cardiovascular arrest. Abdominal computed tomography scan showed an active leak of the intravenous contrast dye in the peritoneum from the splenic aneurysm. We performed an emergent resection of the aneurysm, and peritoneal lavage. Postoperatively, hemorrhagic choc was refractory to large volumes replacement, and intravenous vaso-active drugs. On day 2, he presented massive hematochezia. We performed a total colectomy with splenectomy and cholecystectomy for ischemic colitis, with spleen and gallbladder infarction. Despite vaso-active drugs and aggressive treatment with Factor VIIa, the patient died after uncontrolled disseminated intravascular coagulation.
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