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Laparoscopic aneurysm resection and splenectomy for splenic artery aneurysm in the third trimester of pregnancy

Abstract

Background

Splenic artery aneurysms (SAA) are a rare entity most commonly diagnosed incidentally. Their association with pregnancy increases the risk of rupture resulting in a disproportionately high maternal and fetal mortality. Accordingly, elective surgical treatment is recommended in asymptomatic patients with aneurysms less than 2 cm. In this case, we present a patient during her third trimester of pregnancy with a SAA who was treated by laparoscopic aneurysm resection and splenectomy.

Methods

The patient is a 38-year-old multiparous woman, with an incidental diagnosis of a SAA in 2010. Subsequently, the patient became pregnant and at 27 weeks started to develop abdominal pain. Failed embolization was attempted with worsening of the patient’s symptoms. A CT angiogram revealed a 1.6 cm distal third SAA without any evidence of rupture. Due to the localization of the lesion, the patient was offered a laparoscopic aneurysm resection and splenectomy.

Results

Operating time was 90 min and estimated blood loss was 5 cc. Postoperative fetal monitoring was normal. No perioperative complications were observed. The patient was discharged on postoperative day 3. Two months after laparoscopic splenectomy, the patient delivered a male infant in perfect health.

Conclusions

Although this is a rare disease, the risk of aneurysmal rupture is increased during pregnancy. As a result of high maternal and fetal mortality, elective surgery should be performed. Laparoscopic surgery is the technique of choice.

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Acknowledgments

Special thanks to Ms. Melissa Carton for her careful proofreading of the manuscript.

Disclosures

Dr. Carlos Galvani has received educational grants from Covidien, KARL STORZ Endoscopy, W.L. Gore, Baxter, and Aesculap, equipment grant from Olympus America, Inc., and consulting fees from Covidien and Aesculap. Drs. Julia Samamé, Amit Kaul, Ulises Garza, and Angela Echeverria have no conflict of interest or financial ties to disclose.

Author information

Correspondence to Carlos Galvani.

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Samamé, J., Kaul, A., Garza, U. et al. Laparoscopic aneurysm resection and splenectomy for splenic artery aneurysm in the third trimester of pregnancy. Surg Endosc 27, 2988–2991 (2013) doi:10.1007/s00464-013-2822-x

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Keywords

  • Embolization
  • Laparoscopic splenectomy
  • Pregnancy
  • Splenic artery aneurism