Virginia Via Research Day Book 2026

Medical Student Research Case Reports

45 SPONTANEOUS OVARIAN ARTERY ANEURYSM RUPTURE IN A POSTPARTUM FEMALE

Ben Burkett, OMS-II; Grace Greene, DO; Alison LePera, DO, PhD Corresponding author: bburkett@vt.vcom.edu

VCOM-Virginia, Blacksburg, Virginia Lakeland Regional Hospital, Lakeland, Florida

Differential at that time included preeclampsia with severe features versus pain from acalculous cholecystitis, causing elevated blood pressures. She received IV antihypertensives and magnesium. Returning from an abdominal ultrasound, she had a sudden change in condition with altered mental status and increased abdominal pain. She was tachycardic, and BP was 78/42. Crystalloid bolus and calcium chloride were given. Point of care hemoglobin was 5.1 g/dL. A bedside FAST exam revealed free fluid in the RUQ and LUQ. Massive transfusion protocol was initiated, and she received tranexamic acid. Following initial stabilization, CTA of the abdomen and pelvis showed active hemorrhage in the right adnexa with a large expanding hematoma extending from the right adnexa to right kidney. She was taken emergently to the OR for exploratory laparotomy, which revealed 3L of hemoperitoneum with rupture of the right ovarian artery. Bleeding was controlled, and the right ovary and right fallopian tube were suture ligated and removed. Total, she received 18 units of PRBCs, 15 units of FFP, 4 units of platelets, and 1 unit of cryoprecipitate. She was extubated on post-operative day 2. She was treated with magnesium sulfate for 24 hours and a nicardipine

drip, then transitioned to oral antihypertensives. She developed an acute kidney injury with a max creatinine of 2.68 that was downtrending prior to her discharge on post-operative day #8. Comments: Hemodynamic and endocrine changes during pregnancy can lead to aneurysms in cerebral, splenic, renal, coronary, and ovarian arteries. Few cases of spontaneous ovarian artery aneurysm rupture have been reported in the literature, though most have been associated with pregnancy. This case was unique in that she presented prior to rupture. These ruptures can have catastrophic consequences with hemorrhagic shock and death. Maintaining a broad differential in post partum patients with abdominal pain is important for recognition of this condition and early intervention. Diagnosis: Spontaneous right ovarian artery aneurysm rupture with hemorrhagic shock.

Context: Spontaneous ovarian artery rupture is a rare event that can be associated with pregnancy related conditions. This condition has been infrequently reported in the literature but can be life-threatening. Report of Case: A 28-year-old G3P3003 female who was 5 days postpartum from an uncomplicated spontaneous vaginal delivery of a term infant presented to the emergency department for right-sided abdominal pain, neck pain, headache, and nausea for 3 days. Vital signs were significant for BP 185/98. She denied previous history of hypertension. Physical examination revealed tenderness in her right lower and upper quadrants without rebound or guarding. Labs initially showed leukocytosis of 16.9 K/uL (ref range: 4-10.5 K/uL), hemoglobin 8.7 g/dL (ref range: 12-16 g/dL) and normal platelet count. She had a mildly elevated alkaline phosphatase of 208 U/L (ref range: 46 116 U/L). Urinalysis showed trace protein. CT abdomen and pelvis with IV contrast demonstrated gallbladder wall edema and an enlarged uterus with engorgement of the vascular vessels, thought to be consistent with a postpartum state.

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