gms | German Medical Science

Background: Life-threatening postpartal bleedings are usually associated with well-documented syndromes such as uterine atony or rupture. On a separate level, non-gynaecological syndromes require a differentiated form of diagnosis and urgent treatment, carried out across a number of specialities.

Materials and methods: A 35-year-old patient (VI Gravida / V Para), following an uncomplicated vaginal childbirth, complains of acute abdominal pain, coupled with a progressive deterioration in her general health. The results of Ultrasound and CT-Scan point to an acute abdominal bleeding, and our Gynaecologist colleagues decide to perform an immediate laparotomy. Surgery reveals the Uterus to be undamaged, notwithstanding the massive abdominal bleeding. At this point, the surgical procedure is referred to us in the department of abdominal surgery. After a brief „packing-manoeuvre“, the bursa omentalis is opened and the cause of the problem identified: an aneurysm of the splenic artery, described as "undamaged" prior to surgery. Subsequently, the splenic artery is ligated, the aneurysm removed, and, ulimately, a splenectomy also has to be carried out. Post-surgical convalescence ensues without further complication.

Conclusion: Showing an overall prevalence of 0,1 – 2,0%, visceral artery aneurysms are very rare. The most common outcome (approx. 60%) is that the splenic artery is affected by this kind of alteration, a condition whose clinical relevance lies in the extraordinarily high post-rupture mortality rate of 46 – 75%. It is worth noting that these alterations are influenced through hormones and pregnancy, which is why they are four times as common in women as in men. Rupture risk peaks during third trimenon (25 – 45%) and particularly multiparae are correlated with increased prevalence of occurrence and rupture risk as well. In general, surgery or endovascular techniques both provide possible treatment methods. In the case of rupture and critically ill patients, as described in the instance referred to above, abdominal surgery is preferred, whereas elective interventions show an increasing trend towards the use of endovascular techniques.