Single-port thoracoscopic access for a mediastinal ectopic goiter.

endovascular techniques (stents or selective embolization) or surgery (either open or laparoscopic in selected cases) in order to resect the aneurysm or ligate the splenic artery, while attempting to preserve the spleen. For the diagnosis of ruptured splenic aneurysms, computed tomography with intravenous contrast is the best option in the emergency setting in hemodynamically stable patients. Hemorrhage in the omental bursa, retrogastric hematoma or contrast medium leak at the splenic artery should raise suspicions for the diagnosis and indicate therapeutic angiography with selective embolization. In emergency surgery due to SAA rupture, early aortic clamping (supra-celiac or thoracic) is a very useful maneuver for the initial control of exsanguinating hemorrhage. Afterwards, ligation of the splenic artery is carried out, generally with distal splenopancreatectomy. In our case, vascular control of the thoracic artery was necessary as it was impossible to safely access the abdominal aorta due to the large hematoma; the abdominal approach was used with a midline laparotomy, and ligation of the splenic artery was done with distal splenopancreatectomy. SAA rupture is a rare but potentially fatal complication in pregnancy. It should be suspected in pregnant women with pain in the left hypochondrium and epigastrium and associated hemodynamic instability, especially since early diagnosis and treatment are key for the survival of both the fetus and mother.