Two cases of diagnosis and treatment of splenic artery fibromuscular malformation during pregnancy

Abstract

Aim. Improving the diagnosis and treatment of complications of splenic artery fibromuscular malformation during pregnancy. 

Material and Methods. Two cases of diagnosis and treatment of splenic artery fibromuscular malformation during pregnancy are analyzed.

Results and Discussion. In the first case, a 34-year-old pregnant woman, in the 34-th week of the third pregnancy, the "string of beads" appearance of splenic artery, with 7-8 mm in diameter of proximal portion, 13-14 mm of middle portion, was identified. Caesarean section and splenectomy resulted in discharge of the mother and the baby in good condition on 11-th day. In the second case, in a 30-year-old pregnant woman, in the 30-th week of third pregnancy, a rupture of splenic artery aneurysm, intra-abdominal bleeding, hematoma, spreading on lesser and greater omentum and retroperitoneal tissue, and grade III of hemorrhagic shock caused antepartum fetal death. The splenectomy, Caesarean section in the lower segment of the uterus with removal of the dead fetus, ligation of both internal iliac arteries, and hysterectomy without ovaries were performed. Postoperatively the blockade of ureters at ovarian level, and bilateral ureterohydronephrosis were diagnosed, that resulted in the formation of a left-sided nephrostomy. Thus, early diagnosis, and emergency laparotomy with participation of abdominal and vascular surgeons are crucial in preserving  the lives of the mother and the fetus. 

Conclusion. Splenic artery aneurysm against a background of fibromuscular malformation in pregnant women, a rare clinical disease that is often complicated by rupture and fatal bleeding, is a threat to life of the mother and the fetus. Оbstetricians-gynecologists and urgent abdominal surgeons should consider the rupture of splenic artery aneurysm in any pregnant woman admitted with suspected acute abdomen. Early diagnosis, and emergency laparotomy with participation of abdominal and vascular surgeons are crucial in preserving the lives of the mother and the fetus.