Uncommon Case of Uterine Rupture Associated With Splenic Artery Aneurysm and Rupture During Pregnancy: A Clinical Report and Review of the Literature

We present a case of concomitant splenic artery aneurysmal rupture with uterine rupture in a 32 year-old pregnant woman at 34 weeks of gestation with a history of one previous Cesarean section. The patient presented to the Emergency Department (ED) due to a sudden abdominal pain, which resolved spontaneously. In the ED, she displayed tachycardia, sweating, and lethargy, with no detectable fetal heart rate, raising suspicion of uterine rupture. Surgical exploration revealed significant intra-abdominal hemorrhage from a prior uterine incision, resulting in intrauterine fetal demise (IUFD) and placental abruption. The uterine rupture was promptly repaired, and the uterus remained stable. Subsequently, substantial bleeding and a massive hematoma were discovered. The patient received blood transfusions and underwent surgery to address the source of bleeding, identified as a ruptured splenic artery aneurysm, and successfully managed with packing and ligation. She recovered in the Intensive Care Unit (ICU). This case highlights the rare co-occurrence of uterine rupture and splenic artery aneurysm without apparent changes in vital signs or abdominal findings. In spite of the IUFD and massive hemorrhage, the patient ultimately maintained normal blood pressure.