Unusual emergent presentations of abdominal aortic aneurysm: can simple blood tests predict the state of emergency?

BACKGROUND This paper attempts to see if simple blood test results can predict the state of an emergency aneurysm as being non-ruptured, contained leak or free rupture. METHODS Ninety-three patients who presented to our emergency room and were operated for abdominal aortic aneurysm (AAA) between January 1999 and March 2009 were evaluated retrospectively. Cases were classified as: chronic contained rupture (Group I), impending rupture (Group II), dissecting rupture (Group III), and free rupture (Group IV). RESULTS Chronic contained rupture was determined in 15 (16.1%), impending rupture in 31 (33.3%), dissecting rupture in 14 (15.1%), and true (free) rupture in 27 (29%) cases. Aortocaval fistula was present in 3 (3.2%) patients, aortoenteric fistula in 2 (2.2%) and aorto biliary fistula in 1 (1.1%). Group IV was significantly different from Groups I, II and III with regard to hematocrit levels, white blood cell counts, neutrophils and lymphocyte rates, bicarbonate levels, and mortality rates. CONCLUSION To avoid a delay in diagnosis, it is important to know the different presentations of emergency AAA. In the emergency room, simple laboratory parameters may be highly directive in suspicion of ruptured AAA.