[Rupture of a renal artery aneurysm during delivery].
BACKGROUND
Renal artery aneurysms represent a rare entity with an incidence of 0.3 - 1.3% in angiographies. Rupture of such aneurysms are rare. During pregnancy there is an increased risk of rupture with a high mortality for mother and child. We report the first case of rupture of a left renal artery aneurysm during delivery with survival of mother and child.


METHODS
Due to arrest of labor during a home birth, the patient was admitted to the hospital, where an immediate forceps extraction on account of fetal asphyxia was performed. Immediately after delivery a hypovolemic shock developed. Ultrasound examination showed a huge subsplenic hematoma. Emergency laparotomy revealed a ruptured renal artery aneurysm. The renal artery was ligated on the assumption of a lower pole vessel. Despite hemodynamic stability a drop in hemoglobin occurred the following day. Angiography showed no perfusion of the left kidney. A left nephrectomy was performed without complications. The further course was uneventful. Mother and child survived.


CONCLUSIONS
Rupture of aneurysms of the splenic and renal artery during later stages of pregnancy, during delivery or after childbirth are possible etiologies in cases of unexplained shock and abdominal pain. An emergency angiography in such cases helps to reveal the underlying cause and renders possible a targeted operative approach.
Graff
J
J
Klinik für Urologie und Kinderurologie, Städtisches Klinikum Solingen. graff@klinikumsolingen.de
Schälte
G
G
Jovanovic
V
V
D000328:Adult; D017542:Aneurysm, Ruptured / Q000175:diagnosis* / Q000601:surgery; D001238:Asphyxia Neonatorum / Q000175:diagnosis / Q000601:surgery; D003937:Diagnosis, Differential; D005113:Extraction, Obstetrical; D005260:Female; D006406:Hematoma / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D007231:Infant, Newborn; D009392:Nephrectomy; D007744:Obstetric Labor Complications / Q000175:diagnosis* / Q000601:surgery; D011183:Postoperative Complications / Q000175:diagnosis / Q000601:surgery; D011247:Pregnancy; D012008:Recurrence; D012077:Renal Artery / Q000473:pathology / Q000601:surgery; D012086:Reoperation; D012769:Shock / Q000175:diagnosis / Q000601:surgery; D014593:Uterine Inertia / Q000175:diagnosis / Q000601:surgery