Chronic contained rupture of abdominal aortic aneurysms

Anecdotal reports of chronic contained rupture of abdominal aortic aneurysms exist. Their existence and implications have been largely ignored. From March 1984 to March 1985, 24 patients required repair of an infrarenal abdominal aortic aneurysm. Four patients underwent emergent repair. The remaining 20 patients were evaluated with computed tomography electively. Seven patients (35%) were demonstrated to have a rupture of the aneurysm and a retroperitoneal hematoma on the computed tomographic scan. All of the patients had histories of back or flank pain; five patients continued to complain of mild pain on admission. In no case was shock, impending shock, or a decrease in the hemoglobin level present on admission. All patients were operated on within 24 hours of evaluation. At operation, rupture was noted with organized hematoma outside the aorta contained in a pseudoaneurysmal wall of retroperitoneal connective tissue. There was no intraperitoneal blood. There was no operative mortality and survival was 100% at six months. The CT scan evaluation had identified a subgroup of patients with aneurysms associated with chronic contained rupture.