Splenic Artery Aneurysm in Pregnancy MCQ — NEET PG Practice Question | NEETPGAI
Splenic Artery Aneurysm in Pregnancy
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scissors Surgery
A 28-year-old multiparous woman at 32 weeks gestation presents to the emergency department with sudden-onset severe epigastric pain and hypotension (BP 90/50 mmHg). CT angiography reveals the structure marked **A** in the diagram measuring 2.8 cm with a saccular morphology and mural calcification. She is in hemorrhagic shock with free fluid in the peritoneal cavity. Which of the following is the most appropriate immediate management?
A. Emergency laparotomy with splenectomy and fetal delivery
B. Percutaneous endovascular coil embolization under fluoroscopy
C. Angiographic stent-graft placement with expectant management
D. Observation with serial imaging and delivery at term
Explanation
Why Emergency laparotomy with splenectomy and fetal delivery is right
Rupture of a splenic artery aneurysm (SAA) during pregnancy is a surgical emergency with catastrophic mortality (75% maternal, 95% fetal). The clinical presentation of hemodynamic instability, free intraperitoneal fluid, and confirmed large aneurysm (>2 cm) indicates rupture. The "double rupture" phenomenon—initial contained rupture into the lesser sac followed by free peritoneal rupture—has already progressed to the decompensated stage. At 32 weeks gestation with maternal shock, emergency laparotomy is the only life-saving intervention. Splenectomy is required to control the hemorrhage, and fetal delivery is necessary given the critical maternal condition and periviability of the fetus. Per SVS 2023 and Sabiston 21st ed, ruptured SAA in pregnancy mandates emergency surgical intervention.
Why each distractor is wrong
Percutaneous endovascular coil embolization: While endovascular coil embolization is first-line for elective SAA treatment (>95% success, preserves spleen), it is contraindicated in a hemodynamically unstable, ruptured aneurysm. The patient is in shock and requires immediate hemorrhage control via laparotomy, not the time required for interventional radiology setup and procedure.
Observation with serial imaging and delivery at term: Expectant management is absolutely contraindicated in a ruptured aneurysm with free peritoneal fluid and shock. Observation would result in maternal exsanguination and fetal death. This approach is only appropriate for asymptomatic, unruptured aneurysms detected antenatally.
Angiographic stent-graft placement with expectant management: Stent-graft placement is reserved for proximal aneurysms in stable, elective settings. In a ruptured, hemodynamically unstable patient, this approach delays definitive hemorrhage control and is inappropriate. Expectant management of a ruptured aneurysm is uniformly fatal.
High-YieldNEET PG
Ruptured splenic artery aneurysm in pregnancy = surgical emergency; elective SAA in women of childbearing age = endovascular embolization in second trimester.
SVS 2023; Sabiston Textbook of Surgery 21st ed
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