Atypical manifestations of ruptured abdominal aortic aneurysms.

The rupture of an abdominal aortic aneurysm is a catastrophic event with a uniformly fatal outcome if untreated. The triad of abdominal and/or back pain, a pulsatile abdominal mass, and hypotension, is said to be diagnostic. However, this triad may not be present in its entirety, or when present may not be recognized, as one of the components predominates. Clinical diagnosis is thus 'not infrequently missed in the emergency rooms of even the most prestigious medical centers." To add to this, difficulties in diagnosis may arise owing either to an impalpable aneurysm or to atypical presentations.2'3 The clinical diagnosis is often difficult and not infrequently missed. Consequently, appropriate treatment in the form of expeditious laparotomy, rapid control of the proximal aorta and graft replacement ofthe aneurysmal aorta is not achieved leading to possibly avoidable mortality. The purpose of this report is to discuss less common presentations of ruptured aneurysms of the abdominal aorta, concentrating on the clinical aspects.