Fujii Manato, Yamashita Suguru, Fudono Ayako, Yanai Shuichi, Tashiro Jo, Takenaka Yoshiharu, Yamasaki Kazuki, Ito Eisaku, Masaki Yukiyoshi
Department of Surgery, Ome Municipal General Hospital, 4-16-5 Higashi Ome, Ome-shi, Tokyo, 198-0042, Japan.
Department of Surgery, Ome Municipal General Hospital, 4-16-5 Higashi Ome, Ome-shi, Tokyo, 198-0042, Japan.
Int J Surg Case Rep. 2020;76:94-97. doi: 10.1016/j.ijscr.2020.09.173. Epub 2020 Sep 28.
Pregnancy has been demonstrated as a significant risk factor of splenic artery aneurysm (SAA) formation and rupture. However, prompt diagnosis of SAA rupture in a pregnant patient showing acute abdomen has been practically challenging in light of its rarity and vague initial presentation.
A 40-year-old woman (gravida 1, para 0) at 35 weeks' gestation presented to the emergency department with upper abdominal pain and nausea. Because of fetal dysfunction, emergency caesarian section was performed by a Pfannenstiel incision. Following delivery, 400 g of hemorrhage was removed from the upper abdominal cavity. Computed tomography showed a 37-mm SAA associated with copious adjacent fluid. Although selective angiography did not demonstrate active extravasation, interventional isolation of the SAA was not performed because of multiple surrounding arteries. Relaparotomy with an upper midline incision was then performed. Sudden cardiac arrest occurred upon opening the lesser sac to irrigate clots, and cardiac massage and proximal and distal clamping of the SAA were required. Eventually, splenectomy with excision of the SAA and pancreatic tail was successfully performed, but gauze packing of the open surgical wound was required because of severe coagulopathy. Following removal of the packs and closure of the abdomen 2 days after splenectomy, the patient and infant satisfactorily recovered without sequelae.
Given continual awareness of abdominal vascular collapse during pregnancy, undelayed diagnosis and safer intervention might be achieved.
Awareness at initial presentation and multidisciplinary efforts might be essential to achieve maternal and fetal survival in SAA rupture during pregnancy.
妊娠已被证明是脾动脉瘤（SAA）形成和破裂的重要危险因素。然而，鉴于其罕见性和初始表现模糊，对于出现急腹症的妊娠患者，及时诊断SAA破裂实际上具有挑战性。
一名35周妊娠的40岁女性（孕1产0）因上腹部疼痛和恶心就诊于急诊科。由于胎儿功能障碍，经耻骨联合上横切口行急诊剖宫产。分娩后，从上腹腔清除了400g出血。计算机断层扫描显示一个37mm的SAA，伴有大量邻近液体。尽管选择性血管造影未显示活动性外渗，但由于周围有多个动脉，未对SAA进行介入隔离。随后经上腹部正中切口再次剖腹手术。打开网膜囊冲洗血凝块时突然发生心脏骤停，需要进行心脏按摩以及对SAA进行近端和远端钳夹。最终，成功实施了脾切除术，切除了SAA和胰尾，但由于严重凝血功能障碍，需要对开放手术伤口进行纱布填塞。脾切除术后2天取出纱布并关闭腹部，患者和婴儿恢复良好，无后遗症。
鉴于孕期持续关注腹部血管性虚脱，可能实现及时诊断和更安全的干预。
在妊娠期间SAA破裂时，初始表现时的警惕性和多学科协作对于实现母婴存活可能至关重要。
