Spontaneous rupture of an aneurysm of the splenic artery in pregnancy. Apropos of a new case

The authors report a case of a two para who was admitted as an emergency after collapsing at the end of her pregnancy. Various clinical examinations carried out on admission showed that she was in a state of hypovolemic shock with a marked drop in her blood pressure and a fast pulse as well as pain in the left hypochondrium radiating up to her shoulder. From the obstetrical point of view, there had been no bleeding and no uterine contractions and the fetal heart tracing showed a rate of 135. After intensive efforts at resuscitation an urgent laparotomy was carried out with as a first step Caesarian section which confirmed that there was no pathology in the placenta or uterus, followed by exploration of the abdominal cavity which revealed a large retro-peritoneal haematoma together with a ruptured aneurysm in the hilum of the spleen. Splenectomy was carried out after haemostasis of the splenic pedicle had been performed and this allowed her to recover without complications. Following this case the authors looked up the world literature and confirmed that the pathology was classic but very rare indeed, there being only 66 published cases. As far as its aetiology was concerned this aneurysm is not the same as a classical splenic aneurysm. The development of the aneurysm seems to take place during the pregnancy and the reason for this arterial aneurysm and its rupture in unknown. A theory has been advanced that circulatory and haemodynamic factors acquired in pregnancy reveal the congenital factor that is already present.(ABSTRACT TRUNCATED AT 250 WORDS)