Graff J, Schälte G, Jovanovic V
Klinik für Urologie und Kinderurologie, Städtisches Klinikum Solingen.
Aktuelle Urol. 2003 Sep;34(5):350-3. doi: 10.1055/s-2003-42004.
Renal artery aneurysms represent a rare entity with an incidence of 0.3 - 1.3% in angiographies. Rupture of such aneurysms are rare. During pregnancy there is an increased risk of rupture with a high mortality for mother and child. We report the first case of rupture of a left renal artery aneurysm during delivery with survival of mother and child.
Due to arrest of labor during a home birth, the patient was admitted to the hospital, where an immediate forceps extraction on account of fetal asphyxia was performed. Immediately after delivery a hypovolemic shock developed. Ultrasound examination showed a huge subsplenic hematoma. Emergency laparotomy revealed a ruptured renal artery aneurysm. The renal artery was ligated on the assumption of a lower pole vessel. Despite hemodynamic stability a drop in hemoglobin occurred the following day. Angiography showed no perfusion of the left kidney. A left nephrectomy was performed without complications. The further course was uneventful. Mother and child survived.
Rupture of aneurysms of the splenic and renal artery during later stages of pregnancy, during delivery or after childbirth are possible etiologies in cases of unexplained shock and abdominal pain. An emergency angiography in such cases helps to reveal the underlying cause and renders possible a targeted operative approach.
肾动脉瘤是一种罕见的疾病，在血管造影中的发生率为0.3%-1.3%。此类动脉瘤破裂罕见。孕期破裂风险增加，母婴死亡率高。我们报告首例分娩时左肾动脉瘤破裂且母婴存活的病例。
因在家分娩时产程停滞，患者入院，因胎儿窒息立即行产钳助产。分娩后即刻发生低血容量性休克。超声检查显示脾下有巨大血肿。急诊剖腹探查发现肾动脉动脉瘤破裂。假定为下极血管，结扎肾动脉。尽管血流动力学稳定，但次日血红蛋白仍下降。血管造影显示左肾无灌注。行左肾切除术，无并发症。后续病程顺利。母婴存活。
妊娠晚期、分娩时或产后脾动脉和肾动脉瘤破裂可能是不明原因休克和腹痛病例的病因。此类病例行急诊血管造影有助于揭示潜在病因，并使有针对性的手术方法成为可能。
