SPLENIC ARTERY FIBROMUSCULAR MALFORMATION IN A 29-YEAR-OLD PREGNANT WOMAN: A CASE FROM PRACTICE

Aim. Improving the diagnostics and treatment ofcomplications of splenic artery fibromuscular malformationin pregnant women.Material and Methods. A case of diagnostics and treatmentof complications of splenic artery fibromuscularmalformation in a 29-year-old pregnant woman is analyzed.Results and Discussion. Retrospectively, the idea of apossible adhesive obstruction of the intestines afteradnexitis, appendectomy and chronic pyelonephritis madeit difficult for the obstetricians to promptly diagnose therare complication of pregnancy - the rupture of the splenicartery aneurysm. The situation was deteriorated byabdominal surgeons' underestimation of the patient'scomplaints of the pain in the lower back, reduced amount ofurine, the patient's general weakness, presence of moderatetachycardia, hypochromic anemia, and the free fluid in theepi- and mesogastric regions on ultrasound examination -the symptoms of internal bleeding. Only during laparotomythe source and the volume of blood loss were found. Increasedsurgical intervention - splenectomy, resection of a strand ofthe omentum, accouchement by cesarean section, amputationof the uterus deteriorated the patient's condition. Anotheraggravating factor was the attempt to compensate bloodloss by transfusion of fresh frozen plasma - 1040 ml, 959 mlof packed red blood cells and 800 ml of whole blood from 7donors without using intraoperative blood reperfusion,which led to the development of homologous bloodsyndrome, disseminated intravascular coagulation, multipleorgan dysfunction syndrome and death of the patient.Conclusion. Splenic artery aneurysm against a backgroundof fibromuscular malformation in pregnant women - a rareclinical disease often complicated by rupture and fatalbleeding, is a threat to life of the mother and the fetus.Îbstetricians-gynecologists and urgent abdominal surgeonsshould consider the rupture of splenic artery aneurysm inany pregnant woman who was admitted with suspected acuteabdomen. Early diagnostics, emergency laparotomyinvolving abdominal and vascular surgeons are crucial inthe fight for the lives of the mother and the fetus.