Ruptured abdominal aortic aneurysm presenting with ureteric colic.

SIR,-The article byMrCG Moran and colleagues (16 May, p 1279) acknowledges the difficulty of establishing the diagnosis of ruptured aortic aneurysm and highlights the trap of ureteric colic. Experience at Royal Perth Hospital supports this. This hospital's experience ofpatients with acute renal failure requiring dialysis after repair of abdominal aortic aneurysm has recently been examined. In 29 of 33 such patients surgery followed emergency presentation. Seven of these patients reported symptoms that suggested a diagnosis ofureteric colic, and in four cases pain in or radiating to the testis indicated a ureteric origin. The finding of microscopic haematuria was considered further evidence for this. Back pain was a major symptom in seven other patients, and three patients were being investigated for renal or spinal disease when sudden hypotension or severe abdominal pain, or both, redirected the investigation. Ruptured abdominal aortic aneurysm merits a prominent position in the differential diagnosis of ureteric colic in older patients. For the reasons outlined by Mr Moran and colleagues, the finding of microsopic haematuria should not exclude rupture of an aneurysm from consideration. DAN O'DONNELL