Case Report
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An Unusual Presentation of Ruptured Abdominal Aortic Aneurysm: A Case Report

Year 2022, Volume: 5 Issue: 3, 145 - 148, 30.09.2022
https://doi.org/10.54996/anatolianjem.1051605

Abstract

Aim: Ruptured abdominal aortic aneurysm (AAA) is among the surgical emergencies with highest mortality, generally causes death in 90% of cases. Most AAA ruptures open into the retroperitoneal space, and are recognized by the classical triad of pain, hypotension, and a pulsatile mass. Unfortunately, only 25% to 50% of patients present with this triad; thus, many patients with ruptured AAA either remain undiagnosed or are falsely diagnosed with other diseases.


Case: A 75-year-old man presented to the emergency department (ED) with sudden-onset dyspnea, nausea, and left pelvic pain. Imaging studies revealed aneurysmal dilation of abdominal aorta, inferior to the origin of the renal artery, and intraabdominal free fluid. The patient was consulted with the department of cardiovascular surgery and urgently taken to operating room with the preliminary diagnosis of an AAA rupture.


Conclusion: Our report presents an unusually rare presentation of a life-threatening disorder. Early diagnosis, referral to vascular surgery, and possible open or endovascular repair are key to limiting AAA-related morbidity and mortality.

References

  • Moreira M, Antunes L, Moreira J, Gonçalves Ó. Unusual Presentation of Ruptured Abdominal Aortic Aneurysm. Rev Port Cir Cardiotorac Vasc. 2019;26 (1):71-73.
  • Shreibati JB, Baker LC, Hlatky MA, Mell MW. Impact of the Screening Abdominal Aortic Aneurysms Very Efficiently (SAAAVE) Act on abdominal ultrasonography use among Medicare beneficiaries. Arch Intern Med. 2012;172(19):1456-62. doi: 10.1001/archinternmed.2012.4268.
  • Durdu T, Yilmaz F, Sönmez BM, Ulgen S, Demir A, Yılmaz MS, Arslan ED, Hakbilir O. An unusual presentation of ruptured abdominal aorta aneurysm. Am J Case Rep. 2013 Jul 22;14:267-9. doi: 10.12659/AJCR.889271.
  • Badger S, Forster R, Blair PH, Ellis P, Kee F, Harkin DW. Endovascular treatment for ruptured abdominal aortic aneurysm. Cochrane Database Syst Rev. 2017; 5(5):CD005261. doi: 10.1002/14651858.CD005261.pub4.
  • Chaikof EL, Brewster DC, Dalman RL, Makaroun MS, Illig KA, Sicard GA, Timaran CH, Upchurch GR Jr, Veith FJ; Society for Vascular Surgery. The care of patients with an abdominal aortic aneurysm: the Society for Vascular Surgery practice guidelines. J Vasc Surg. 2009;50(4 Suppl):S2-49. doi: 10.1016/j.jvs.2009.07.002.
  • Wanhainen A. How to define an abdominal aortic aneurysm--influence on epidemiology and clinical practice. Scand J Surg. 2008;97(2):105-9; discussion 109. doi: 10.1177/145749690809700204.
  • Altobelli E, Rapacchietta L, Profeta VF, Fagnano R. Risk Factors for Abdominal Aortic Aneurysm in Population-Based Studies: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2018;15(12):2805. doi: 10.3390/ijerph15122805.
  • Kent KC, Zwolak RM, Egorova NN, Riles TS, Manganaro A, Moskowitz AJ, Gelijns AC, Greco G. Analysis of risk factors for abdominal aortic aneurysm in a cohort of more than 3 million individuals. J Vasc Surg. 2010;52(3):539-48. doi: 10.1016/j.jvs.2010.05.090. Epub 2010 Jul 13.
  • Jeanmonod D, Yelamanchili VS, Jeanmonod R. Abdominal Aortic Aneurysm Rupture. 2021 Aug 11. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–. PMID: 29083705.
  • Assar AN, Zarins CK. Ruptured abdominal aortic aneurysm: a surgical emergency with many clinical presentations. Postgrad Med J. 2009;85(1003):268-73. doi: 10.1136/pgmj.2008.074666.

Rüptüre Abdominal Aort Anevrizmasının Olağandışı Bir Başvurusu: Olgu Sunumu

Year 2022, Volume: 5 Issue: 3, 145 - 148, 30.09.2022
https://doi.org/10.54996/anatolianjem.1051605

Abstract

Amaç: Rüptüre abdominal aort anevrizması (AAA) mortalitesi en yüksek cerrahi aciller arasındadır ve vakaların %90'ında ölüme neden olur. Çoğu AAA rüptürü retroperitoneal boşluğa açılır ve klasik bulguları olan ağrı, hipotansiyon ve pulsatil kitle üçlüsü ile tanınır. Ne yazık ki, hastaların sadece %25 ile %50'si bu üçlü ile başvurur; bu nedenle, AAA rüptürü olan birçok hasta ya teşhis edilmeden kalır ya da başka hastalıklarla yanlış teşhis konur.


Olgu: 75 yaşında erkek hasta ani başlayan nefes darlığı, bulantı ve sol pelvik ağrı şikayetleri ile acil servise (AS) başvurdu. Görüntüleme yöntemleri, renal arterin çıktığı yerin altında yer alan abdominal aortun anevrizmal dilatasyonunu ve intraabdominal serbest sıvıyı ortaya çıkardı. Hasta kalp damar cerrahisi bölümü ile konsülte edildi ve AAA rüptürü ön tanısı ile acilen ameliyathaneye alındı.


Sonuç: Bu vakamız, yaşamı tehdit eden bir bozukluğun alışılmadık derecede nadir görülen bir presentasyonunu gösteriyor. Erken tanı, vasküler cerrahiye sevk ve olası açık veya endovasküler onarım, AAA ile ilişkili morbidite ve mortaliteyi sınırlamanın temel anahtarıdır.

References

  • Moreira M, Antunes L, Moreira J, Gonçalves Ó. Unusual Presentation of Ruptured Abdominal Aortic Aneurysm. Rev Port Cir Cardiotorac Vasc. 2019;26 (1):71-73.
  • Shreibati JB, Baker LC, Hlatky MA, Mell MW. Impact of the Screening Abdominal Aortic Aneurysms Very Efficiently (SAAAVE) Act on abdominal ultrasonography use among Medicare beneficiaries. Arch Intern Med. 2012;172(19):1456-62. doi: 10.1001/archinternmed.2012.4268.
  • Durdu T, Yilmaz F, Sönmez BM, Ulgen S, Demir A, Yılmaz MS, Arslan ED, Hakbilir O. An unusual presentation of ruptured abdominal aorta aneurysm. Am J Case Rep. 2013 Jul 22;14:267-9. doi: 10.12659/AJCR.889271.
  • Badger S, Forster R, Blair PH, Ellis P, Kee F, Harkin DW. Endovascular treatment for ruptured abdominal aortic aneurysm. Cochrane Database Syst Rev. 2017; 5(5):CD005261. doi: 10.1002/14651858.CD005261.pub4.
  • Chaikof EL, Brewster DC, Dalman RL, Makaroun MS, Illig KA, Sicard GA, Timaran CH, Upchurch GR Jr, Veith FJ; Society for Vascular Surgery. The care of patients with an abdominal aortic aneurysm: the Society for Vascular Surgery practice guidelines. J Vasc Surg. 2009;50(4 Suppl):S2-49. doi: 10.1016/j.jvs.2009.07.002.
  • Wanhainen A. How to define an abdominal aortic aneurysm--influence on epidemiology and clinical practice. Scand J Surg. 2008;97(2):105-9; discussion 109. doi: 10.1177/145749690809700204.
  • Altobelli E, Rapacchietta L, Profeta VF, Fagnano R. Risk Factors for Abdominal Aortic Aneurysm in Population-Based Studies: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2018;15(12):2805. doi: 10.3390/ijerph15122805.
  • Kent KC, Zwolak RM, Egorova NN, Riles TS, Manganaro A, Moskowitz AJ, Gelijns AC, Greco G. Analysis of risk factors for abdominal aortic aneurysm in a cohort of more than 3 million individuals. J Vasc Surg. 2010;52(3):539-48. doi: 10.1016/j.jvs.2010.05.090. Epub 2010 Jul 13.
  • Jeanmonod D, Yelamanchili VS, Jeanmonod R. Abdominal Aortic Aneurysm Rupture. 2021 Aug 11. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–. PMID: 29083705.
  • Assar AN, Zarins CK. Ruptured abdominal aortic aneurysm: a surgical emergency with many clinical presentations. Postgrad Med J. 2009;85(1003):268-73. doi: 10.1136/pgmj.2008.074666.
There are 10 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Case Report
Authors

Fevzi Yılmaz 0000-0002-3675-7457

Fadime Kara 0000-0003-0619-1496

Esra Sönmez Üçkapı This is me 0000-0002-9966-9331

Publication Date September 30, 2022
Published in Issue Year 2022 Volume: 5 Issue: 3

Cite

AMA Yılmaz F, Kara F, Sönmez Üçkapı E. An Unusual Presentation of Ruptured Abdominal Aortic Aneurysm: A Case Report. Anatolian J Emerg Med. September 2022;5(3):145-148. doi:10.54996/anatolianjem.1051605