Spontaneous Adrenal Haemorrhage in Early Twin Pregnancy: A Case Report of Successful Conservative Management

Case Report

Austin Surg Case Rep. 2022; 7(1): 1049.

Spontaneous Adrenal Haemorrhage in Early Twin Pregnancy: A Case Report of Successful Conservative Management

Youssef El Mahdaouy¹*, Mohamed Aziz Fadili¹, Yassin Bouhtouri², Abdelhamid Benlghazi², Noureddine Njoumi¹ and Abdelmounaim Ait Ali¹

¹Departement of Visceral Surgery II, Military Hospital of Instruction Mohamed V, Rabat, Morocco

²Departement of Gynecology and Obstetrics, Military Hospital of Instruction Mohamed V, Rabat, Morocco

*Corresponding author: Youssef El Mahdaouy, Departement of Visceral Surgery II, Military Hospital of Instruction Mohamed V, Rabat, Morocco

Received: May 17, 2022; Accepted: June 16, 2022; Published: June 23, 2022

Abstract

Spontaneous adrenal haemorrhage in pregnancy is an extremely rare condition. Herein we present an additional case of unilateral spontaneous adrenal haemorrhage in a 31-year-old pregnant woman at the 15 weeks of gestation with successful conservative management and a safe vaginal delivery.

Keywords: Adrenal Haemorrhage; Pregnancy; Spontaneous

Abbreviation

SAH: Spontaneous Adrenal Haemorrhage; MRI: Magnetic Resonance Imaging.

Introduction

Spontaneous adrenal haemorrhage (SAH) in pregnancy is a rare condition. Given the absence of a specific clinical presentation, SAH should be considered in the differential diagnosis of abdominal or flank pain and signs of shock at different gestational age. Any delay of the diagnosis is potentially life threatening for both mother and fetus by adrenal crisis if bilateral or in case of massive bleeding.

In this article, we present a rare case of unilateral SAH in early pregnancy with successful conservative management.

Case Report

A 31-year-old nulliparous woman, in the 15 weeks of gestation, was referred to our emergency department with intense left flank pain, radiating to the left upper quadrant abdominal, worsening with deep respiration, accompanied by vomiting. The pain started 4 weeks ago and was progressive recently.

On admission, the patient’s vital signs showed blood pressure of 100/60 mmHg, pulse rate of 128 beats per minute, tachypneic of 21 breaths per minute with oxygen saturation of 100 % on air room. The patient was afebrile (37,1 C°). The fetal heart rate was normal for both of the twins.

The previous medical history was unremarkable and there was no history of major surgery, recent abdominal trauma or underlying illness. The patient denied any use of drugs or anticoagulants.

At initial physical examination, there was tenderness in left upper quadrant. The uterus found soft, the cervix closed and no vaginal bleeding was present.

The complete blood count showed the following results: hemoglobin 6,8g/dl, erythrocyte 3,4 106/uL, hematocrit 29%, leucocytes 7,6 103/uL, thrombocytes 312 103/uL. Coagulation test, liver function test, renal function test, C-reactive protein and lipase were all within normal limits.

Prior to imaging, patient’s general condition established at intensive care unit with blood transfusion (3 units) and 1000 ml of colloid intravenous infusion. Intravenous narcotic were prescribed to control the pain.

The patient’s vital signs improved, her blood pressure increased to 110/80 mmHg, pulse rate decreased to 86 beats per minute and hemoglobin level drooped to 9,7g/dL. The fetal heart rate was still normal for both of the twin.

Transvaginal ultrasound showed a live intrauterine pregnancy with a normal appearing anterior placenta and appropriate fetal growth. Abdominal ultrasound showed a well defined and lobulated heterogeneous mass of 14×13 cm behind the left kidney. The left adrenal haemorrhage was suspected.

Considering the stable condition of the patient, she was admitted for abservation. One day later, an abdominal ultrasound was repeated and showed no change in size of the mass.

The adrenal function was tested in blood (total cortisol) and in 24- hour urine collection (free cortisol, metanephrine, normetanephrine) and were normal.

Because of gestation, an abdominal magnetic resonance imaging (MRI) was scheduled and showed a well-limited round mass of 12,4×13,3×15,6 cm in the left adrenal region with no recognize able left adrenal gland. The mass was heterogeneous with a hyperintense signal on the T1-weigted and T2-weigted images. Also, the mass was lobulated with a low signal on the T1-weighted images and high signal on the T2-weighted images in some areas, which consist with recurrent bleeding or hematoma (Figure 1). The diagnosis was a spontaneous adrenal haemorrhage in different stages.

Citation: El Mahdaouy Y, Fadili MA, Bouhtouri Y, Benlghazi A, Njoumi N and Ait Ali A. Spontaneous Adrenal Haemorrhage in Early Twin Pregnancy: A Case Report of Successful Conservative Management. Austin Surg Case Rep. 2022; 7(1): 1049.