Nonvascular emergencies presenting as ruptured abdominal aortic aneurysms

Patients may present with signs and symptoms of ruptured abdominal aortic aneurysm (RAA) but actually have other diseases mimicking RAA. The outcome of these patients has not been reported.

During the past 10 years, 16 patients presumed to have RAAs were found at operation to have other diseases accounting for the symptoms. Fifteen patients (94%) had abdominal pain, 9 (56%) had a pulsatile abdominal mass, and 7 (44%) were hypotensive on presentation.

Ten of the 16 patients had intact aortic aneurysms at surgery; there were no reliable physical signs or diagnostic tests that could discern between RAAs and intact aneurysms with other intraabdominal diseases. Eight patients (50%) died in the perioperative period, including four with widespread metastases, three with overwhelming sepsis, and one with an acute myocardial infarction. None of the 10 patients with aneurysms suffered RAA after emergency laparotomy. Exploratory laparotomy was necessary to treat underlying disease in nine patients and was probably harmful only to the patient with a myocardial infarction. Two survivors with aneurysms underwent successful staged repairs.

Mistaken diagnoses in patients who are suspected of having RAAs on the basis of physical findings are relatively uncommon. Exploratory laparotomies are required to correct the primary disease in most of these misdiagnosed patients. Few die as a direct result of laparotomy; true iatrogenic catastrophes associated with mistaken diagnoses are distinctly uncommon.