Reduction in mortality from ruptured abdominal aortic aneurysm can be achieved by prompt recognition of established clinical manifestations. In addi tion to the classic symptoms and signs, incarceration of a previously reducible groin hernia has occasionally led to the diagnosis of aneurysmal rupture. This report details the first known case of acute incarceration of an epigastric (inci sional) hernia secondary to ruptured abdominal aortic aneurysm. It serves to underscore the necessity of maintaining a high index of suspicion for occult aneurysmal rupture when a patient presents with incarceration of any previ ously reducible abdominal wall hernia.

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