Gebelikte Splenik Arter Anevrizmasının Rüptürü: Olgu Sunumu

Yıl 2020, Cilt: 3 Sayı: 2, 51 - 53, 30.06.2020

Engin Özakın

Öz

Amaç: Splenik arter anevrizması, yüksek mortalite riski taşıyan nadir bir durumdur. Bu olgumuzda ani başlangıçlı şiddetli sol üst kadran ve karın ağrısı, sol omuzda rahatsızlık ve kardiyovasküler kollaps ile başvuran gebe hastayı sunmayı amaçladık.

Olgu: Bayılma nedeniyle acil servise getirilen 28 yaşında 20 haftalık gebe hastanın öyküsünde 1 hafta önce spontan abortusa bağlı küretaj öyküsü mevcuttu. Başvuruda değerlendirmede genel durumu orta-kötü, bilinç konfüze saptandı. Vital bulgular; kan basıncı:80/50 mmHg, Nabız:121 atım/dk, solunum sayısı:24 /dk ve GKS : 12 (E:3, M:4, V5) olarak ölçüldü. Yatakbaşı USG’de karın içi serbest sıvı saptanması üzerine yapılan abdominopelvik BT’de splenik arter rüptürü tespit edildi. Genel cerrahi bölümü tarafından laparotomi uygulan hasta, takibinin 8. Saatinde eksitus oldu.

Sonuç: Splenik arter rüptürü gerek anne gerekse fetüs açısından yüksek mortaliteye sahiptir. Acil tıp hekimleri şokta gelen gebe hastalarda splenik arter rüptürünü akılda bulundurmalıdır.

Anahtar Kelimeler

Splenik arter, anevrizma, gebelik

Destekleyen Kurum

Yok

Teşekkür

Yok

Rupture Of A Splenic Artery Aneurysm During Pregnancy: Case Report

Öz

Aim: Splenic artery aneurysm is a rare condition which carries a high mortality risk. In this case, we aimed to present a pregnant patient presenting with sudden onset severe left upper quadrant and abdominal pain, discomfort in the left shoulder and cardiovascular collapse.

Case: 28-year-old pregnant woman (20th weeks) was brought to the emergency department due to syncope. She had a history of dilatation/curettage due to spontaneous abortion 1 week ago. On admission, she was confused and her the general condition was moderate-bad. Vital signs; blood pressure: 80/50 mmHg, pulse: 121 beats / min, respiratory rate: 24 / min and GKS: 12 (E: 3, M: 4, V5). Splenic artery rupture was detected in abdominopelvic CT performed upon detection of intra-abdominal free fluid in bedside USG. The patient underwent laparotomy by the general surgery department and died at the 8th hour of the follow-up.

Conlusion: Splenic artery rupture has a high mortality in terms of both mother and fetus. Emergency physicians should keep in mind the splenic artery rupture in pregnant patients who are in shock.

Anahtar Kelimeler

Splenic artery, aneursym, pregnancy

Kaynakça

• Feo CF, Scanu AM, Fancellu A, Costantino S. Visceral aneurysm and vascular anomaly involving the splenic artery. Dig Dis Sci. 2004;49(9):1378-1380.
• Pasha SF, Gloviczki P, Stanson AW, Kamath PS. Splanchnic artery aneurysms. Mayo Clin Proc. 2007;82(4):472-479.
• Al-Habbal Y, Christophi C, Muralidharan V. Aneurysms of the splenic artery - a review. Surgeon. 2010;8(4):223-231.
• Bakhos CT, McIntosh BC, Nukta FA, et al. Staged arterial embolization and surgical resection of a giant splenic artery aneurysm. Ann Vasc Surg. 2007;21(2):208-210.
• Selo-Ojeme DO, Welch CC. Review: spontaneous rupture of splenic artery aneurysm in pregnancy. Eur J Obstet Gynecol Reprod Biol. 2003;109(2):124-127.
• Veschambre P, Coppo B, Grosieux P. [Rupture of aneurysm of the splenic artery during the first three months of pregnancy]. Presse Med. 1993;22(33):1693-1694.
• Di Vella G, Arpaio A, Marzullo A, Colonna M. Rupture of the spleen or splenic vessels (splenic emergency syndrome) in late pregnancy: a report of two autopsy cases. Forensic Sci Int. 2008;176(2-3):e1-5.
• Angelakis EJ, Bair WE, Barone JE, Lincer RM. Splenic artery aneurysm rupture during pregnancy. Obstet Gynecol Surv. 1993;48(3):145-148.
• Caillouette JC, Merchant EB. Ruptured splenic artery aneurysm in pregnancy. Twelfth reported case with maternal and fetal survival. Am J Obstet Gynecol. 1993;168(6 Pt 1):1810-1811; discussion 1811-1813.
• Gallot D, Bournazeau JA, Amblard J, Pouly JL, Lemery D. [Rupture of a splenic artery aneurysm during pregnancy. Report of a case]. J Gynecol Obstet Biol Reprod (Paris). 1999;28(2):168-170.
• Groussolles M, Jr., Merveille M, Alacoque X, Vayssiere C, Reme JM, Parant O. Rupture of a splenic artery aneurysm in the first trimester of pregnancy. J Emerg Med. 2011;41(1):e13-16.
• Sadat U, Dar O, Walsh S, Varty K. Splenic artery aneurysms in pregnancy--a systematic review. Int J Surg. 2008;6(3):261-265.
• Richardson AJ, Bahlool S, Knight J. Ruptured splenic artery aneurysm in pregnancy presenting in a manner similar to pulmonary embolus. Anaesthesia. 2006;61(2):187-189.
• Abdulrahman A, Shabkah A, Hassanain M, Aljiffry M. Ruptured spontaneous splenic artery aneurysm: A case report and review of the literature. Int J Surg Case Rep. 2014;5(10):754-757.