Renal artery aneurysm rupture in the immediate puerperium: an uncommon cause of hypovolemic shock after cesarean section

Abstract

Renal artery aneurysm (RAA) is a rare vascular condition, with a prevalence of less than 1%; however, it becomes particularly relevant during pregnancy because of the increased risk of rupture, with maternal mortality exceeding 50% and fetal mortality greater than 70%. Most RAAs remain asymptomatic, which delays diagnosis until acute events occur. This report describes the case of a 33-year-old woman at 36.4 weeks of gestation who developed severe abdominal pain, acute anemia, and hypovolemic shock after an emergency cesarean section. Computed tomography angiography revealed rupture of a saccular aneurysm in a segmental branch of the right renal artery, with active bleeding and an extensive retroperitoneal hematoma. Given the patient’s hemodynamic instability and the lack of immediate availability of endovascular treatment, emergency right nephrectomy was performed, followed by intensive care management under a massive transfusion protocol, with a favorable clinical course. This case highlights the importance of early recognition, a multidisciplinary approach, and timely surgical intervention as decisive measures for maternal survival.