Fatal ruptured unrecognised aortic aneurysm

Thirty years ago, a 24-year-old teacher attended hospital, suffering from persistent stomach pains, more pronounced around the navel, along with nausea; she vomited several times with several diarrhoeal stools. When admitted to the emergency room, she had normal vital normal laboratory findings, and the basic X-ray image of the abdomen did not indicate intra-abdominal perforation and ileus. On palpation, her abdomen was continuously diffusely painful, and the elastic wall had no defence musculature; there was no back pain. Given the clinical picture of a "pseudoacute abdomen", the patient was examined by an internist, surgeon and gynaecologist. Three hours after admission, during examination, the patient suffered a fatal cardiorespiratory arrest which did not respond to resuscitation procedures which were applied immediately and for one hour. At autopsy, an infraceliac complete asymmetrical ruptured abdominal aortal aneurysm of the posterolateral wall, 9 cm in length, was found with massive coagulum and fresh blood filling the entire retroperitoneum. Pathohistologically, a typical lesion of abdominal aortal aneurysm dissection into media with intimal fragmentation, intramural haematoma and mild atherosclerotic plaques was proven. The cause of sudden death was declared to be unknown, spontaneous, non-traumatic ruptured abdominal aortal aneurysm with massive retroperitoneal bleeding and ireversible haemorrhagic shock.