Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 6, 2022; 10(25): 9057-9063
Published online Sep 6, 2022. doi: 10.12998/wjcc.v10.i25.9057
Ruptured splenic artery aneurysms in pregnancy and usefulness of endovascular treatment in selective patients: A case report and review of literature
Sang Hun Lee, Songsoo Yang, Inkyu Park, Yeong Cheol Im, Gyu Yeol Kim
Sang Hun Lee, Department of Obstetrics and Gynecology, Ulsan University and Ulsan University Hospital, Ulsan 44033, South Korea
Songsoo Yang, Inkyu Park, Yeong Cheol Im, Gyu Yeol Kim, Department of Surgery, Ulsan University and Ulsan University Hospital, Ulsan 44033, South Korea
Author contributions: Yang S conceived the report; Lee SH and Yang S wrote the first draft with input from all authors; Park I and Im YC carried out the literature search and provided the figures; Yang S and Kim GY revised the manuscript for important intellectual content; all authors issued final approval for the version to be submitted.
Informed consent statement: This case report was approved by the Institutional Ethical Committee in our hospital and written informed consent was obtained from the patient.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Songsoo Yang, MD, PhD, Professor, Department of Surgery, Ulsan University and Ulsan University Hospital, 881, Bangeojinsunhwando-ro, Dong-gu, Ulsan 44033, South Korea. paul913@hanmail.net
Received: April 13, 2022
Peer-review started: April 13, 2022
First decision: May 12, 2022
Revised: May 25, 2022
Accepted: July 18, 2022
Article in press: July 18, 2022
Published online: September 6, 2022
Processing time: 135 Days and 5.3 Hours
Abstract
BACKGROUND

The rupture of a splenic artery aneurysm (SAA) in pregnancy is an uncommon condition. However, it is associated with high mortality rates in pregnant women and fetuses even after surgical treatment. Though the endovascular treatment of SAAs is currently preferred as it can improve the outcomes even in emergent cases, the endovascular treatment of a ruptured SAA during pregnancy has not been reported until date.

CASE SUMMARY

We report a case of a 33-year-old woman with the sudden onset of epigastric pain due to a ruptured SAA at the mid-portion of the splenic artery at 18 wk of pregnancy. After emergent initial resuscitation, the patient was diagnosed with a ruptured SAA through digital angiography. Immediately upon diagnosis, she underwent emergent endovascular embolization of the splenic artery for the rupture on the spot. Next, surgery was performed to remove the hematoma under stable conditions. Although the fetus was found to be dead during resuscitation, the woman recovered without complications and was discharged 15 d postoperatively.

CONCLUSION

Endovascular treatment might be a valuable alternative to surgery/lead to safer surgery for selected pregnant patients with ruptured SAAs.

Keywords: Splenic artery; Aneurysm; Pregnancy; Endovascular treatment; Case report

Core Tip: Though the endovascular treatment of a splenic artery aneurysm (SAA) is currently preferred as it can improve outcomes, endovascular treatment for a ruptured SAA during pregnancy has not been reported. It is still debatable whether a primary emergent laparotomy or angiographic embolization of an SAA followed by laparotomy is the best approach. However, similar to our case, when the patients whose vital signs are too unstable to wait for surgery or in hemodynamically unstable pregnant patients with a low chance of fetal survival, the endovascular treatment should be considered. This might be a valuable alternative to surgery/lead to safer surgery.