[Ruptured aortic aneurysm as an unexpected finding in laparotomy for acute abdomen]

The ruptured abdominal aortic aneurysm as an incidental finding in emergency laparotomy for acute abdominal symptoms is a rare event. For this reason it is more important to know the necessary diagnostic and therapeutic strategies. Nowadays sonography facilitates the preoperative diagnosis. The performance of an additional computed tomography or angiography depends on the clinical appearance of the patient. In hemodynamically instable patients with a ruptured aneurysm, an immediate laparotomy is mandatory. If intraoperatively the aortic aneurysm has a diameter of more than 5 cm and shows no signs of rupture, implantation of an aortic prosthesis is indicated. This procedure has also priority when patients with a ruptured aneurysm are suffering from an additional abdominal disease. If additional septic reasons are diagnosed intraoperatively, the abdominal operation has to be performed synchronously with the aortic prosthesis. Alternatively, the use of an antimicrobial vascular prosthesis or resection of the aortic aneurysm with extra-anatomic bypass has to be considered. The technical difficulty of the operation is in the control of the proximal aorta. The lethality of operations for ruptured aneurysm has been consisted high (between 21 and 70%) in the past. In an elective operation, mortality has how improved up to 5%. This indicates that the essential prognostic factors, degree of retroperitoneal hematoma and hemorrhagic shock, and the condition of the patient, are not influenced by modern patient management. However, a further dominant prognostic parameter for lethality, how qualified the surgeon is in vascular surgery, can be influential.