title: Endovascular management of renal artery aneurysm rupture in pregnancy - A case report.
abstract: BACKGROUND
  Renal artery aneurysm rupture is an extremely rare cause of acute abdominal pain and haemodynamic instability in pregnancy. Due to its rarity, the diagnosis may not be immediately considered, and therefore there is a high associated mortality rate for both mother and fetus.
  
  
  METHODS
  We present a case of a 41-year old primigravida who presented to the obstetricians at 22 weeks' gestation with severe abdominal pain, shock and fetal loss. A bleeding renal artery aneurysm was discovered at laparotomy and radiologically coiled with sacrifice of the left kidney. Treatment of a contralateral aneurysm by autotransplantation of the remaining kidney allowed for preservation of residual renal function.
  
  
  CONCLUSIONS
  Surgical acute abdominal presentations can be difficult to interpret in pregnant patients. Pregnancy is known to be a contributing risk factor for spontaneous rupture of renal artery aneurysms, an otherwise rare mode of aneurysm presentation. Prompt use of imaging to diagnose and treat non-obstetric causes of the acute abdomen should not be delayed because of perceived risks to the fetus. Endovascular arrest of aneurysmal haemorrhage may be more effect in the context of a gravid uterus than surgical management.
  
  
  CONCLUSIONS
  In the shocked pregnant patient with an acute abdominal presentation, visceral artery aneurysm rupture may be comparatively more common, and should be considered in the absence of other localizing symptoms. Prompt interventional radiological treatment may be lifesaving in such cases.
authors.affiliation: Department of Surgery, Royal London Hospital, UK. Electronic address: lizzie@maughans.net.
authors.forename: E
authors.initials: E
authors.lastname: Maughan
authors.affiliation: Department of Surgery, Royal London Hospital, UK.
authors.forename: C
authors.initials: C
authors.lastname: Webster
authors.affiliation: Department of Surgery, Royal London Hospital, UK.
authors.forename: T
authors.initials: T
authors.lastname: Konig
authors.affiliation: Department of Interventional Radiology, Royal London Hospital, UK.
authors.forename: I
authors.initials: I
authors.lastname: Renfrew
keywords: Bilateral aneurysm; Endovascular aneurysmal treatment; Pregnancy; Renal artery aneurysm; Rupture