Meysam Moghbeli, Ph.D,
North Khorasan University of Medical Sciences,
Trauma is the most cause of spleen rupture, spontaneous rupture of the splenic aneurism is a rare problem which causes a massive bleeding inside the abdomen, and ultimately reduces blood pressure, shock, and death. Here we reported a rare rupture of splenic aneurysm in pregnant woman with abdominal pain and reduced blood pressure. Splenectomy was performed after the stabilization. This problem is a life-threatening condition during the pregnancy and surgical intervention is the best treatment option.
Spleen is a fragile and hemorrhagic organ which is prone to a huge bleeding due to a small trauma . Splenic artery aneurysm (SAA) is the third and most common type of abdominal and visceral artery aneurysms . Spleen rupture is normally in line with a trauma and spontaneous rupture is known for the rupture in patients without any history of trauma, systemic disease, and clear pathological results.
Spontaneous spleen aneurysm rupture during the pregnancy leads to a high ratio of mortality because of the late diagnosis and treatment . It has been reported that the mortality rate of spontaneous spleen rupture is 35% in pregnant and 70% in fetus . Spontaneous spleen rupture was reported in 1803 for the first time and 9 cases were observed until 1880 who were the consequences of autopsy. However, the first case of rupture was reported in 1898 in which the patient was undergone the splenectomy. In both of pregnant and normal patients the clinical manifestations are severe abdominal bleeding, left flank pain, blood pressure reduction, and anemia . In the present study, we reported a pregnant case with spontaneous splenic aneurysm rupture to represent the importance of such problem during the pregnancy.
Spleen is a congested organ and receives 5% of blood. Therefore every rupture will results in severe abdominal bleeding, Hypovolemia, Tachycardia, upper left abdominal pain, Kehr’s sign, and diaphragm stimulation . Several reasons are involved in spontaneous splenic rupture in pregnant such as uterus growth in the last months of pregnancy, contraction of abdominal muscles, enlarged spleen, and small aneurysms ruptured spleen. Regarding the present case of a pregnant female with spontaneous spleen rupture without any specific reason, it will be prescribed to consider the spontaneous spleen rupture in pregnant who claims about the severe abdominal pain and bleeding. Although, the spontaneous splenic rupture is a rare problem among the pregnant, it is commonly observed between 6-9 months of pregnancy. Among the reported splenic ruptures between 1950-2011, 332 out of 631 cases were consequences of colonoscopy, 210 cases were related to an inflammation, and 39 cases were related to the anomalies, non hemorrhagic neoplasm, internal trauma, and pregnancy. Only 15 out of 631 cases have shown a spontaneous splenic rupture without any reason.
Splenic rupture will results in a high ratio of mortality among the fetuses and pregnant. The best treatment option is splenectomy along with Pneumococcal and Influenza vaccines. In present study we reported a pregnant woman who claimed about low blood pressure, Tachycardia, and severe abdominal pain. Clinical and sonographic examinations also showed abdominal distention, generalized tenderness, and free liquid in left pelvic cavity. Therefore the laparotomy and splenectomy were performed to save the women and fetus.