Aneurysms of the Abdominal Aorta *

Following one encounter with a case of ruptured abdominal aneurysm which was of considerable interest, it seemed desirable to look up the hospital cases of this disease entity and to review the literature briefly. It was very soon clear that the diagnosis of aneurysm of the abdominal aorta was no medical frill, for more than one general surgeon or urologist has operated only to find that an aneurysm was present, rather than a retroperitoneal tumor or a perinephric abscess. Although the disease is frequently, if not invariably, fatal, the confusion caused by its various manifestations makes it desirable to know the limitations, in order that we may attempt to distinguish it from the other disease entities with similar signs and symptoms. Aneurysms of the aorta, itself, are not rare, but those of the abdominal aorta are infrequent to say the least, and comprise only a small fraction of all aortic aneurysms. Osler, in 1905, stated that they were observed only eleven times in 22,000 autopsies at Johns Hopkins Hospital, and that the ratio of abdominal to thoracic types was 1:10. Lucke and Rea,6 in 1921, stated the ratio as 1:5.1, and Kampmeier,4 in 1936, as 1:7.8. During the thirteen-year period from 1934 to 1947, at St. Luke's Hospital only nine cases were clearly proved by autopsy or operation, with a ratio of 1:3. The age at which signs and symptoms become manifest varies according to the etiology, but in general they are first noted during the fifth and sixth decades. Bryant, reviewing 54 cases, states that 63 per cent were forty years of age or under, and Kampmeier notes that 68 per cent of his cases were under forty-five. Ruffin, Castleman, and White point out that the average age at death with syphilis as the causative agent was 46.4 years, and with arteriosclerosis 72.7 years. Average age for the nine cases proved here was 63. Males are far more frequently affected than are females, 88 per cent of Kampmeier's and 90 per cent of Bryant's cases being males. Racial distribution, however, varies with the etiological agent, as well as with the location of the hospital where the survey is made. Scott, in