Splenic artery aneurysm occurs in approximately 0.1% of all adults. It is estimated that 6% to 10% of splenic artery aneurysms will rupture, and 25% to 40% of those ruptures will occur during pregnancy, especially during the third trimester. Risk factors for rupture include portal hypertension and pregnancy. Maternal mortality for ruptured splenic artery aneurysm is 75%, and fetal mortality is up to 95%. Patients with a splenic artery aneurysm before rupture are fairly asymptomatic; vague epigastric pain, left upper quadrant pain, and left shoulder pain is among the most common complaints.

Radiologic studies for the diagnosis of splenic artery aneurysms include plain abdominal film, ultrasound, and angiography. On plain abdominal film, an oval calcification with a central lucent area is a very specific sign of an aneurysm. In pregnancy, ultrasound evaluation with the Doppler study is preferred to minimize radiation exposure to the fetus. Angiography is the gold standard when the patient is stable, but this procedure increases radiation exposure to the fetus.

Because of the high morbidity and mortality associated with a ruptured aneurysms, treatment for pregnant women and women of childbearing age consists of elective splenic artery ligation and resection of the aneurysm with or without splenectomy. Treatment of suspected ruptured aneurysm is immediate laparotomy. Pneumococcal vaccine should be given 2 weeks before elective splenectomy and immediately following emergency splenectomy.

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