Clinical suspicion and instrumental diagnosis of ruptured abdominal aortic aneurysms

The authors report their experience in the management of 54 patients who underwent emergency surgery for rupture of an abdominal aortic aneurysm, correlating results to time of diagnosis. The overall mortality rate was 55.5%. The extent and the site of bleeding, free blood in peritoneal cavity or retroperitoneal hematoma alone, were critical factors influencing survival and were correlated to early of diagnosis. Patients with small hematomas had no mortality; cases with more extensive hematomas had a mortality rate of 53%; in case of intraperitoneal bleeding the mortality rose to 73% (p = 0.001). The median times between symptoms' onset and surgical intervention was correlated with a significant value to extent of retroperitoneal hematoma (p = 0.003). This time is also significantly different in dead patients compared to survivors (p < 0.001). In patients with uncorrect admitting diagnosis the mean times between onset of symptoms and surgical treatment was significantly different from time of correctly diagnosed patients (p < 0.001). Our findings emphasize the need for rapid recognition of prodromal symptoms of rupture and the earlier referral of patients with known abdominal aneurysm; we suggest that in an unstable patient with a suspected ruptured aneurysm immediate surgery should be performed without delay for confirmatory tests or full resuscitation.