Presentation Title

Spontaneous Splenic Artery Aneurysm in Third Trimester Pregnancy

Format

Poster

Start Date

6-11-2020 9:45 AM

End Date

6-11-2020 10:00 AM

Abstract

Spontaneous splenic artery aneurysm rupture in a pregnant patient is an extremely rare complication that poses significant challenges to the multidisciplinary teams of Anesthesia, Obstetrics, and Surgery. All of which are required to stabilize both mother and fetus. This medical anomaly is associated with a high rate of both maternal mortality (75%) and fetal mortality (95%). With very few cases currently documented in the literature, further understanding will help implement protocols for higher rates of successful management. CASE DESCRIPTION A 26-years-old female, G2P1A0L1, in her 32nd week of pregnancy, presented to the Emergency Department with sudden onset of left-sided abdominal pain, associated with near syncope, shortness of breath and decreased fetal movements. The patient exhibited generalized pallor, lethargy, delayed capillary refill, tachycardia (130 bpm), Blood pressure 90/48. Point-Of-Care Ultrasound Focused Assessment with Sonography in Trauma (POCUS FAST) exam was positive for hemoperitoneum with fetal heart rate at 40 beats per minute. Uterine rupture was suspected and the patient underwent emergency C-section. Upon delivering the viable, anemic preterm boy (APGAR 0,4,4), no evidence of uterine rupture was found and the procedure was converted to an exploratory laparotomy. On opening of the lesser sack, multiple large hematomas were removed and the ruptured splenic artery aneurysm was ligated. Distal pancreatectomy with splenectomy was performed. Anesthesia resuscitated the patient with total of 36 units of blood products: 22 units packed RBCs, 10 FFP, 3 platelets and 1 cryoprecipitate. The post-operative course is ongoing as the mother is in ICU and baby in NICU. DISCUSSION The spontaneous rupture of a splenic artery aneurysm during pregnancy is a rare, but deadly threat for both mother and fetus. Consideration for the condition should be given to any pregnant women who present with sudden onset abdominal pain and hemodynamic instability. Swift recognition and coordination by healthcare providers are paramount to maternal and fetal survival.

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Nov 6th, 9:45 AM Nov 6th, 10:00 AM

Spontaneous Splenic Artery Aneurysm in Third Trimester Pregnancy

Spontaneous splenic artery aneurysm rupture in a pregnant patient is an extremely rare complication that poses significant challenges to the multidisciplinary teams of Anesthesia, Obstetrics, and Surgery. All of which are required to stabilize both mother and fetus. This medical anomaly is associated with a high rate of both maternal mortality (75%) and fetal mortality (95%). With very few cases currently documented in the literature, further understanding will help implement protocols for higher rates of successful management. CASE DESCRIPTION A 26-years-old female, G2P1A0L1, in her 32nd week of pregnancy, presented to the Emergency Department with sudden onset of left-sided abdominal pain, associated with near syncope, shortness of breath and decreased fetal movements. The patient exhibited generalized pallor, lethargy, delayed capillary refill, tachycardia (130 bpm), Blood pressure 90/48. Point-Of-Care Ultrasound Focused Assessment with Sonography in Trauma (POCUS FAST) exam was positive for hemoperitoneum with fetal heart rate at 40 beats per minute. Uterine rupture was suspected and the patient underwent emergency C-section. Upon delivering the viable, anemic preterm boy (APGAR 0,4,4), no evidence of uterine rupture was found and the procedure was converted to an exploratory laparotomy. On opening of the lesser sack, multiple large hematomas were removed and the ruptured splenic artery aneurysm was ligated. Distal pancreatectomy with splenectomy was performed. Anesthesia resuscitated the patient with total of 36 units of blood products: 22 units packed RBCs, 10 FFP, 3 platelets and 1 cryoprecipitate. The post-operative course is ongoing as the mother is in ICU and baby in NICU. DISCUSSION The spontaneous rupture of a splenic artery aneurysm during pregnancy is a rare, but deadly threat for both mother and fetus. Consideration for the condition should be given to any pregnant women who present with sudden onset abdominal pain and hemodynamic instability. Swift recognition and coordination by healthcare providers are paramount to maternal and fetal survival.