title: Splenic artery rupture during pregnancy concealed by a pancreatic lymphangioma: a rare co-occurrence.
abstract: A pregnant woman presented to a local hospital with abdominal pain and hemorrhagic shock. Emergency caesarean section ruled out an obstetric cause and revealed a large mass, interpreted as a hematoma, with active bleeding of unknown origin. Because of her poor clinical condition, the patient was admitted to our hospital. Computed tomographic findings were suspicious for bleeding originating from the splenic artery. Laparotomy confirmed the presence of a ruptured splenic artery. A splenic artery aneurysm-a relatively well known entity during pregnancy-was absent. Hemostasis was achieved by clipping the artery. A large pancreatic cystic mass, which was misinterpreted earlier as a hematoma, was surgically removed. The pathologic examination revealed a pancreatic lymphangioma, an uncommon benign tumor. The ruptured splenic artery was presumably related to the pancreatic lymphangioma and vascular changes caused by pregnancy. A splenic artery rupture in co-occurrence of a pancreatic lymphangioma is a unique presentation which has not been reported previously.
authors.affiliation: Department of Internal Medicine, Ziekenhuisgroep Twente, Almelo, The Netherlands. de.boumans@zgt.nl
authors.forename: Dennis
authors.initials: D
authors.lastname: Boumans
authors.forename: Linda B M
authors.initials: LB
authors.lastname: Weerink
authors.forename: Aart T
authors.initials: AT
authors.lastname: Rheineck Leyssius
authors.forename: Paul
authors.initials: P
authors.lastname: Swartbol
authors.forename: Thiemo F
authors.initials: TF
authors.lastname: Veneman
mesh_terms: D000328:Adult; D002585:Cesarean Section; D003951:Diagnostic Errors; D005260:Female; D006439:Hemodynamics; D006470:Hemorrhage / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D006489:Hemostatic Techniques; D006801:Humans; D008202:Lymphangioma / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D011237:Predictive Value of Tests; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D011252:Pregnancy Complications, Neoplastic / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D012422:Rupture, Spontaneous; D013157:Splenic Artery / Q000503:physiopathology / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome