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Nonvascular emergencies presenting as ruptured abdominal aortic aneurysms
R J Valentine1, M J Barth, S I Myers
1Department of Surgery, University of Texas Southwestern Medical Center, Dallas 75235.
Surgery
|March 1, 1993
Summary
Mistaken diagnoses of ruptured abdominal aortic aneurysm (RAA) are uncommon. Exploratory laparotomies are often needed for misdiagnosed patients, with few deaths directly from the procedure.
Area of Science:
- Vascular Surgery
- Abdominal Aortic Aneurysm Research
- Surgical Diagnostics
Background:
- Patients presenting with signs of ruptured abdominal aortic aneurysm (RAA) may have other mimicking conditions.
- Outcomes for patients misdiagnosed with RAA have not been previously reported.
Purpose of the Study:
- To report the outcomes of patients presumed to have RAA but found to have other diseases during surgery.
- To evaluate the necessity and safety of exploratory laparotomies in these misdiagnosed cases.
Main Methods:
- Retrospective review of 16 patients over 10 years with suspected RAA but alternative diagnoses found at operation.
- Analysis of presenting symptoms (abdominal pain, pulsatile mass, hypotension) and surgical findings.
Main Results:
- 10 patients had intact aortic aneurysms; distinguishing RAA from other intra-abdominal diseases was difficult.
- 50% of patients died perioperatively due to comorbidities (metastases, sepsis, myocardial infarction).
- Exploratory laparotomy was necessary for primary disease treatment in most cases and rarely harmful.
Conclusions:
- Misdiagnoses in suspected RAA cases are infrequent.
- Exploratory laparotomies are essential for treating the actual underlying conditions in misdiagnosed patients.
- Direct iatrogenic harm from laparotomy in these cases is uncommon.