Splenic artery rupture after trauma in a 23-year-old patient in second trimester with gastric bypass Milzarterienruptur nach Sturz bei einer 23-jährigen Patientin im zweiten Schwangerschaftstrimester mit Magenbypass

Introduction:

The Roux-Y gastric bypass surgery was once considered the gold standard of bariatric operations. Its market share decreased fewer than 50% since 2011 due to its complexity and complication rate. A possible complication might be a rupture of vessels of the lienal hilus as a result of adhesions which could lead to Splenectomy. Besides the danger of blood loss other factors as pregnancy may lead to further consequences.

Case presentation:

We present the case of a 23-year-old primipara who underwent emergency-splenectomy after minor abdominal trauma. The bleeding was caused by a splenic artery rupture that occurred most likely because of a prior gastric-bypass operation. The patient left the hospital with a vital fetus in 25th week of gestation after 14 days of hospitalization. Further pregnancy controls were unsuspicious. After primary cesarean section on schedule, the child shoed symptoms of severe hypoxic encephalopathy.

Results/Conclusion:

Apart from pregnancy-induced complaints as preeclampsia, gastritis or gastro-esophageal-reflux late complications of bariatric surgeries always need to be considered in patients with upper abdominal pain. Minor trauma might lead to severe consequences for mother and child.

Tab. 1:

Timeline

2 – 20 – 2017	Trauma after orthostatic dysregulation
2 – 20 – 2017 7:11pm	Admission to hospital – analgesia, observation
2 – 21 – 2017 8:45am	Morning rounds – worse general condition
2 – 21 – 2017 9:36am	Transabdominal ultrasound – free fluid
2 – 21 – 2017	Emergency surgery with splenectomy
2 – 24 – 2017	Discharge from ICU
3 – 6-2017	Discharge from hospital
3 – 20 – 2017	Sonography control: vital fetus
6 – 13 – 2017	Primary Cesarean Section