Sudden Rupture of Splenic Artery Aneurysm in a Pregnant Woman Resulting in the Death of the Fetus: A Case Report and Review of Literature

Background: Visceral artery aneurysm is an uncommon pathology with a potential risk of rupture and disastrous complications, especially during pregnancy. Sudden rupture is associated with higher fetal mortality. The exact etiology of splenic artery aneurysm remains unclear. However, intimomedial mucoid degeneration is a rare vascular disorder that can lead to aneurysms in young individuals. Case Presentation: In this case, we present a case of unexpected and sudden intra-abdominal hemorrhage in a 26-year-old woman in her first pregnancy (27th week) with fetal death but maternal survival. At the onset, blood pressure was 90/70 mmHg, and blood tests showed anemia. The transabdominal ultrasound showed fluid in the sub-hepatic area and a significantly slowed fetal heartbeat. Cesarean section was performed, and upon opening the abdomen, there was a massive hemoperitoneum, and the incision of the uterus led to the extraction of a dead fetus. Surgical pathology revealed an aneurysm of the splenic artery, and histological examination supported a diagnosis of intimomedial mucoid degeneration of the vessel. Conclusion: Abdominal pain in pregnancy is a frequent presentation in obstetric departments with a wide possibility of diagnosis. Clinicians face significant diagnostic challenges due to the wide range of potential causes of abdominal pain. The rarity of this pathology and the objective diagnostic difficulties make this condition obscure and unpredictable. Routine screening of the splenic artery with ultrasound and Doppler can be considered in pregnant women with predisposing factors. Timely surgical intervention is necessary to spare the life of the mother and the fetus.