Ballout Rami A, Ghanem Rayan, Nassar Anwar, Hallal Ali H, Ghulmiyyah Labib M
Faculty of Medicine, American University of Beirut, Beirut, Lebanon.
Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon.
J Womens Health Dev. 2019;2(1):19-27. doi: 10.26502/fjwhd.2644-2884004. Epub 2019 May 20.
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.
这是一名38岁的黎巴嫩女性患者，孕2产1，有剖宫产史，孕30⁺⁵周时出现急性左侧胁腹疼痛，伴有寒战和排尿困难2天。根据临床表现，患者最初被诊断为肾盂肾炎并进行相应治疗；然而，尽管采取了复苏措施且腹部超声检查正常，但她的临床状况仍因低血压和嗜睡加重而恶化。未能使患者苏醒最终导致心脏骤停，遂在床边进行了濒死剖宫产。打开腹腔后，发现一个正在出血的破裂脾动脉瘤（SAA），于是启动了大量输血方案，并将患者转至手术室。患者术后病程复杂，胎儿为死产，住院6个月后出院回家。鉴于妊娠期间破裂SAA相关的高死亡率和发病率，早期识别和及时干预对母婴有益至关重要。
