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Clinical Presentation of RAAA

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Ruptured Abdominal Aortic Aneurysm

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Abstract

Despite the widespread belief that a ruptured abdominal aortic aneurysm (RAAA) presents with the classical triad of back pain with or without abdominal pain, hypotension, and a pulsatile abdominal mass [1], this triad is only present in one fourth to half of all RAAA patients [2, 3]. Depending on the site of rupture, the comorbidities of the patient, and conditions of the institution or rescue team, RAAA may be misdiagnosed in up to 30 % of patients [2]: myocardial infarction, ureteral stone, peptic ulcer, perforation of the stomach or duodenum, gallstones, or even diverticulitis are often suspected, and their respective diagnostic pathway may considerably delay the diagnosis and treatment of life-threatening RAAA. In contrast, vascular surgeons must be aware that those diseases may mimic RAAA and that these misdiagnoses can be quite troublesome when RAAA is only detected after emergency laparotomy. In chronic contained rupture (CCR) of abdominal aortic aneurysms (AAA) [4, 5], clinical presentation and signs may be even more subtle and misleading. Patients may present with full-blown abdominal compartment syndrome (ACS) [6], which may be missed when the focus is put on the rupture of the aorta and its rapid sealing.

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  1. Hospital of Zurich, Zurich, Switzerland

    Dieter Mayer MD, FEBVS, FAPWCA

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  1. Dieter Mayer MD, FEBVS, FAPWCA
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  1. Division of Vascular Surgery, University of Washington Harborview Medical Center, Seattle, Washington, USA

    Benjamin W. Starnes

  2. Albany Medical Center, Albany, New York, USA

    Manish Mehta

  3. Bronx, New York, USA

    Frank J. Veith

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Mayer, D. (2017). Clinical Presentation of RAAA. In: Starnes, B., Mehta, M., Veith, F. (eds) Ruptured Abdominal Aortic Aneurysm. Springer, Cham. https://doi.org/10.1007/978-3-319-23844-9_6

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