Management of ruptured splenic artery aneurysm in pregnancy: a life-threatening emergency

Splenic artery aneurysm (SAA) rupture in pregnancy is a rare but life-threatening event. We report the case of a 30 week pregnant patient with class III obesity, who presented with circulatory collapse and vague abdominal pain. The diagnosis was confounded by her body habitus and atypical symptoms. With the initial differential of obstetric haemorrhage, an emergency caesarean delivery was performed for foetal bradycardia, but unfortunately, despite aggressive resuscitation, the neonate did not survive. During surgical exploration, a ruptured SAA was diagnosed and successfully repaired. She required massive transfusion exceeding 15 L of blood loss but survived this life-threatening event. Her post-operative course was complicated by wound infection, atelectasis and foot drop, and she was discharged after 46 days. This case underscores the difficulty of distinguishing SAA rupture from obstetric causes of haemorrhage and highlights the critical importance of rapid recognition and multidisciplinary intervention to ensure maternal survival, particularly in high-risk pregnancies.