Aortic aneurysm rupture in a postpartum patient with antiphospholipid syndrome: a case report

An abdominal aortic aneurysm (AAA) is a localized dilatation of the infrarenal Aorta. The antiphospholipid syndrome (APS) is defined by the persistent presence of antiphospholipid antibodies in patients with recurrent venous or arterial thromboembolism or pregnancy morbidity.

A 38-year-old woman, with a known case of APS, was referred to the emergency department three days after undergoing her second cesarean section. She presented with a 3-day history of fatigue and weakness with tachycardia and decreased blood pressure. Because of unstable hemodynamics, portable ultrasonography was performed and revealed intra-abdominal massive hematoma and free fluid with debris in the abdominal and pelvic spaces, the surgical team performed an exploratory laparotomy to assess the extent of the internal bleeding and to address the identified hematomas. A midline incision was performed for exploratory laparotomy, revealing a massive extraperitoneal hematoma in Zone 1 which ruptured immediately, not allowing the origin of the hematoma to be identified. Then cardiovascular collapse happened. Despite resuscitative efforts, including prolonged cardiopulmonary resuscitation for 30 minutes, the patient did not respond and was pronounced dead.

In this case, early detection of an AAA and prompt investigation might have enabled safer management of the pregnancy and cesarean section complications.

In this case, early detection of an AAA and prompt investigation might have enabled safer management of the pregnancy and cesarean section complications.