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Ruptured abdominal aortic aneurysm presenting as symptomatic inguinal mass: report of six cases
Insights
Ruptured abdominal aortic aneurysms can present as groin masses in elderly men, leading to a 50% mortality rate. Prompt diagnosis and surgical intervention are crucial for improving survival in these complex cases.
Area of Science:
- Vascular Surgery
- Emergency Medicine
- Geriatric Medicine
Background:
- Ruptured abdominal aortic aneurysms (rAAA) are a life-threatening condition.
- Unusual presentations can delay diagnosis and treatment.
Observation:
- Six elderly males (mean age 73) presented with groin masses due to rAAA.
- A palpable abdominal mass was noted in 33% of patients.
- All underwent aortic aneurysmectomy, with a 50% mortality rate.
Findings:
- Delayed diagnosis, preoperative hypotension, advanced age, poor nutrition, and blood loss contributed to high mortality.
- Retroperitoneal anatomy and scrotal-kidney channel development are implicated in this presentation.
Implications:
- A high index of suspicion is essential for emergency room staff.
- Prompt surgical intervention is mandatory to improve outcomes for this rare rAAA presentation.
Abstract:
Six elderly male patients (mean age, 73 years; range, 66 to 78 years) were admitted with groin masses caused by ruptured abdominal aortic aneurysms. A palpable abdominal mass was present in 33%. All patients eventually underwent abdominal aortic aneurysmectomy with a resultant mortality rate of 50%. Delayed diagnosis, preoperative hypotension, advanced age, poor nutritional status, and excessive intraoperative blood loss were factors contributing to this high mortality rate. In this unusual clinical presentation of ruptured abdominal aortic aneurysm, a high index of suspicion by the emergency room staff and prompt surgical intervention are mandatory to improve mortality rates. The anatomy of the retroperitoneal space and the phylogenetic development of a channel between the scrotum and the kidney are important factors in the development of this symptom complex.