Abstract
A 39-year-old G5P3A1 woman at 30 weeks of gestation with a twin pregnancy presented to the hospital with abdominal and epigastric pain. Her pain was initially attributed to uterine contractions. Following the diagnosis of intrauterine fetal death (IUFD), she was admitted to the labor and delivery unit for induction, and the twins were delivered with Apgar scores of 0. The patient's hemoglobin level dropped to 7 g/dL, prompting the administration of packed red blood cell (pRBC) transfusions, which appropriately improved her hemoglobin. She was discharged five days later with stable vital signs. However, due to a rapid deterioration in her clinical condition on the day of discharge, she presented to another referral hospital. Based on severe hypotension, a hemoglobin level of 7.2 g/dL, and an ultrasound reporting abundant free intra-abdominal fluid, the patient was immediately transferred to the operating room. Approximately 4.5 liters of blood and clots were evacuated from the abdominal cavity, and a splenectomy was performed following the diagnosis of a ruptured splenic artery aneurysm (SAA). Due to her deteriorating general condition and recurrent bleeding from the surgical site, she was taken back to the operating room the following day, where an additional 2 liters of blood were evacuated. Ultimately, despite aggressive resuscitation efforts, the patient developed bradycardia, became unresponsive, and expired in the intensive care unit (ICU) secondary to recurrent hemorrhage from the surgical site.
Research Insight
· Ruptured splenic artery aneurysm (SAA) must be considered a primary differential diagnosis in pregnant patients presenting with acute abdominal pain, given its life-threatening nature.
· Prompt diagnosis and immediate therapeutic intervention are pivotal in mitigating the high risk of maternal and fetal mortality associated with this condition.
· Successful outcomes necessitate a highly coordinated, multidisciplinary approach involving obstetricians, general and vascular surgeons, anesthesiologists, and intensive care specialists.
· Because the clinical manifestations of SAA rupture are often nonspecific and can mimic more common causes of acute abdomen in pregnancy, clinicians must maintain a high index of clinical suspicion to avoid catastrophic diagnostic delays.