Spontaneous Rupture of Internal Iliac Artery in Pregnancy: Case Report

• Published in: Acta clinica Croatica (Tisak) Vol. 57; no. 1; pp. 157 - 160
• Main Authors: Butorac, Dražan, Djaković, Ivka, Košec, Vesna, Kopjar, Miroslav, Kuna, Krunoslav
• Format: Journal Article
• Language: English
• Published: Croatia Klinicki bolnicki centar Sestre milosrdnice 01.03.2018; Sestre Milosrdnice University Hospital and Institute of Clinical Medical Research, Vinogradska cesta c. 29 Zagreb; Sestre Milosrdnice University hospital, Institute of Clinical Medical Research
• Subjects: Abdomen, acute; Abdominal pain; Adult; Care and treatment; Case Report; Case studies; Cesarean Section; Diagnosis; Female; Health aspects; Humans; Iliac artery; Iliac Artery - pathology; Pregnancy; Pregnancy Complications; Rupture, Spontaneous; Uterus; Croatia; Pregnancy; Abdominal pain; Abdomen, acute; Cesarean section; Iliac artery
• ISSN: 0353-9466; 1333-9451
• DOI: 10.20471/acc.2018.57.01.20

Rupture of the internal iliac artery is a rare complication in pregnancy that is associated with maternal and fetal morbidity and mortality. We present a case of a 30-year-old primipara admitted to our department in 39th week of gestation after sudden onset of intense abdominal pain. On admission, the patient was pale, tachycardiac, but with normal blood pressure and afebrile. Symptoms of acute abdomen were clear and surgery was indicated. Diagnosis was confirmed during cesarean section. Enlarged gravid uterus compressed the ruptured artery and prevented heavier bleeding. Acute bleeding due to arterial rupture causes severe symptoms, predominantly abdominal pain. Changes in blood count become significant some time after the onset of rupture. As the gravid uterus compressed the arterial rupture, preoperative bleeding was by far less abundant than the bleeding after the baby had been delivered and the size of the uterus decreased. Any cause of acute abdomen during pregnancy (abruption of the placenta, spleen rupture, visceral artery thrombosis) requires urgent surgical treatment, as well as intraoperative and postoperative intensive treatment. Rupture of the internal iliac artery is a rare complication in pregnancy, but has to be considered as a differential diagnosis of abdominal pain.