Splenic vein rupture in pregnancy: A case report and systematic review of the literature.

Splenic vein aneurysm (SVA) rupture is a rare clinical entity, with few case reports detailing its occurrence during pregnancy. We describe a case of a SVA rupture and present a systematic review of the literature in relation to splenic vein rupture, with or without aneurysm. Our case was of a 30-year-old woman, Para 4 at 37 weeks' gestation who presented with significant abdominal pain and subsequent maternal collapse. Massive intra-abdominal hemorrhage was identified, with splenic vessel rupture suspected. A splenectomy and partial pancreatectomy were performed along with massive blood product transfusion. There was both maternal and fetal survival with no long-term sequelae at follow-up. Histological examination of the spleen and its vessels noted a SVA rupture. In a subsequent systematic review of the literature, we identified 10 cases of splenic vein rupture with only two previously documented cases of SVA rupture in pregnancy. Maternal and fetal survival has only been reported in two cases of splenic vein rupture, with ours being a third.

Obstetric rectal buttonhole tears: A case series and literature review.

INTRODUCTION: Isolated rectal buttonhole tears are a rare obstetric complication and so there is a lack of consensus for their management. The current case series reviews the published literature on obstetric rectal buttonhole injuries and provides further cases from our institution. METHODS: A literature review was performed and all results were reviewed. Rectal buttonhole tears following vaginal delivery between 2012 and 2022 in our institution were identified. Repair technique and postoperative management were recorded. RESULTS: There were 14 published case reports. Seven case reports described a two-layer closure, and seven reports described a three-layer closure. Four cases were repaired in collaboration with colorectal surgeons. Twelve cases were asymptomatic after 6 weeks. One woman had a defunctioning stoma following a wound breakdown and one woman was readmitted with a rectal hemorrhage. We identified two women in our institution with buttonhole tears. Three-layer repairs were performed in both cases and each woman made an uneventful recovery. CONCLUSION: Repair techniques of rectal buttonhole tears vary among institutions. Despite this variance, most women experience no short-term morbidity following these injuries. This review adds to the current literature with examples of different repair techniques and outcomes.