What is the incidence and mortality rate of a ruptured celiac (celiac trunk) aneurysm during a cesarean section (c-section)?

Ruptured Celiac Artery Aneurysm During C-Section: Incidence and Mortality

Ruptured celiac artery aneurysms during cesarean section are extraordinarily rare, but when they occur, they are catastrophic with mortality rates approaching 100% if not immediately recognized and treated. 1

Epidemiology of Celiac Artery Aneurysms

Celiac artery aneurysms are exceptionally uncommon vascular lesions:

• Account for only 4% of all visceral artery aneurysms, making them the fourth most common type after splenic (60%), hepatic (20%), and superior mesenteric artery aneurysms (6-7%). 2, 3

• The overall incidence in the general population is not well-established due to their rarity, but they represent approximately 5.9% of all visceral arterial aneurysms in surgical series. 4

• Most celiac artery aneurysms are asymptomatic at diagnosis and discovered incidentally on imaging performed for other reasons. 4, 5

Rupture Risk and Mortality

General Population Rupture Statistics

• The overall rupture risk is approximately 13% in untreated celiac artery aneurysms. 6

• When rupture occurs in non-pregnant patients, the mortality rate ranges from 40% to 100%, depending on the speed of diagnosis and intervention. 1, 6

• In contrast, elective repair carries a much lower mortality rate of only 5%. 1, 6

Pregnancy-Specific Considerations

While the provided evidence does not contain specific data on celiac artery aneurysm rupture during cesarean section, critical context from splenic artery aneurysms (the most common visceral aneurysm) provides important parallels:

• Splenic artery aneurysm rupture during pregnancy carries maternal mortality of 70% and fetal mortality exceeding 90%. 2

• Pregnancy creates a hyperdynamic circulatory state, particularly in the third trimester, which maximizes blood flow through visceral vessels and increases rupture risk. 2

• Up to 50% of splenic artery aneurysms that rupture during pregnancy are less than 2 cm in diameter, indicating that pregnancy itself dramatically increases rupture risk regardless of aneurysm size. 2

Clinical Reality: Specific to C-Section

The specific incidence of celiac artery aneurysm rupture during cesarean section is not reported in the medical literature, likely because:

1. Celiac artery aneurysms themselves are extremely rare (4% of visceral aneurysms). 2, 3

2. Most are asymptomatic and undiagnosed prior to pregnancy. 4, 5

3. The combination of having an undiagnosed celiac artery aneurysm AND undergoing cesarean section represents an exceedingly rare clinical scenario.

4. When rupture does occur, it is often misattributed to more common causes of intraoperative hemorrhage (uterine atony, placental complications, uterine rupture). 7

Key Clinical Pitfalls

If a pregnant patient presents with severe abdominal pain, syncope, and hemodynamic instability—particularly in the third trimester or peripartum period—visceral artery aneurysm rupture must be considered, even though it is rare. 2

The classic presentation includes:

• Sudden severe abdominal pain radiating to the back or flank 2
• Hemodynamic collapse disproportionate to visible blood loss 2
• Abdominal distension and peritoneal signs 2

Any known visceral artery aneurysm in a woman of childbearing age warrants prophylactic treatment before conception, regardless of size, given the catastrophic mortality rates if rupture occurs during pregnancy. 2