Spontaneous Splenic Hemorrhage and Portal Hypertension in Pregnancy: A Combined Catheter Based and Surgical Approach

Objectives: To review the management of portal hypertension and splenic hemorrhage in pregnancy. Methods: A retrospective case review. Results: A 22-year-old female, with past history of portal hypertension, variceal hemorrhage and thrombocytopenia presented at 22 weeks of pregnancy with spontaneous splenic hemorrhage. Her portal hypertension was a consequence of intra-hepatic sclerosis following treatment of acute cell lymphoma in childhood. Because of the risk of variceal hemorrhage as pregnancy progressed, Transjugular Hepatic Portosystemic Shunt (TIPS) was performed first, followed a few days later by splenic artery embolization and splenectomy in a combined setting. The patient has subsequently delivered a healthy girl. Conclusion: In the era of hybrid suites, catheter and surgical based approaches can more easily be combined. In this setting, the patient had dual risks as pregnancy advanced: variceal hemorrhage and splenic rupture. The combined approach permitted splenectomy without the need for transfusion.