Ruptured abdominal aortic aneurysm: initial misdiagnosis and the effect on treatment

To evaluate the incidence of misdiagnosis in ruptured abdominal aortic aneurysm and its effect on treatment and outcome.

Retrospective study.

Teaching hospital, The Netherlands.

97 consecutive patients admitted with ruptured abdominal aortic aneurysm during the 5-year period, 1 January 1989--31 December 1993.

Initial diagnosis, interval between onset of symptoms and admission, and mortality.

38 Patients (43%) presented with symptoms of their aneurysm exceeding nine hours prior to admission (range 10 hours to 14 days, median 2 days). Fifty patients (60%) were initially misdiagnosed by the referring practitioner. Ultrasonography was consistent with rupture in only 36/70 (51%). 52 Patients died (54%), (operative mortality 45 (46%)), and was not affected by delay in diagnosis or treatment.

Although delay in diagnosis or treatment did not seem to affect mortality, improved awareness of non-specific presentations of (imminent) rupture will result in fewer misdiagnoses and earlier treatment. A group of patients will undoubtedly benefit from this as they can be operated on at a stage when expected mortality is lower.