Ruptured splenic artery aneurysm in the 35 th week of pregnancy. Medical error or bad luck? Case report

A 29-year-old woman, para 2 gravida 2, at 35 weeks gestation, came to her local hospital with a sudden onset of severe pain in the left abdomen with associated pain in the back. After 12 hours, the second ultrasonography demonstrated the existence of free fluid in the peritoneal cavity, which was found to be bloody. The surgeon pronounced ruptured spleen the cause of hemorrhage. The autopsy as a direct cause of death revealed massive hemorrhage in the retroperitoneal space and in the peritoneal cavity from a ruptured splenic artery aneurysm. In most cases only double rupture phenomena, in which the hematoma in the lesser sac temporarily tamponades the bleeding aneurysm, is responsible for maternal and fetal survival. In our case, even though the surgeons had about 12 hours to diagnose and treat ruptured the splenic artery aneurysm, they did not succeeded to save the lives of the mother and fetus. Their indifference and delayed surgery intervention cost two lives. Key W ords: aneurysm of splenic artery, rupture, pregnancy, medical error