Ruptured abdominal aortic aneurysm

Chlariello, Luigi; Reul, George J.; Wukasch, Don C.; Sandiford, Frank M.; Hallman, Grady L.; Cooley, Denton A.

doi:10.1016/0002-9610(74)90060-9

Cited by 33 publications

(9 citation statements)

References 15 publications

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“…is always present" (italics added for emphasis) (4,5,8). Other authors have found pain to be slightly less prevalent, with rates closer to 90% (6,7,9,10). Indeed, our case of painless ruptured AAA does not seem to be a novel finding, as Pryor explicitly pointed out 25 years ago that "unfortunately, in some patients pain may be absent on admission .…”

Section: Discussioncontrasting

confidence: 46%

“…When the condition goes entirely unrecognized, the mortality has been reported to be as high as 100%, imploring clinicians to become familiar with less common manifestations of ruptured AAA (4). In classic and atypical presentations alike, severe pain seems to be the most conspicuous symptom, present in 90 -100% of patients (1,(5)(6)(7)(8). Here we present an unusual case of painless penile and scrotal ecchymosis as the sole presenting sign of ruptured AAA.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Ruptured Abdominal Aortic Aneurysm Presenting as Painless Testicular Ecchymosis: The Scrotal Sign of Bryant Revisited

Dargin¹,

Lowenstein²

2011

The Journal of Emergency Medicine

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Section: Discussioncontrasting

confidence: 46%

Section: Introductionmentioning

confidence: 99%

Ruptured Abdominal Aortic Aneurysm Presenting as Painless Testicular Ecchymosis: The Scrotal Sign of Bryant Revisited

Dargin¹,

Lowenstein²

2011

The Journal of Emergency Medicine

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“…The fact that normotensive patients have lower mortality rates than hypotensive patients has been clearly documented in numerous studies. 3,6,7,[9][10][11]13,16,20,22,23 This decreased mortality is most likely related to the absence of free rupture into the peritoneal cavity with exsanguination and the lack of superimposed cardiac and renal impairment due to decreased perfusion and ischemia.…”

Section: Methodsmentioning

confidence: 99%

Surgonomics: The Costs of Ruptured Abdominal Aortic Aneurysm

Muñoz¹,

Kassan²,

Chang³

1988

Angiology

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Surgical care costs continue to rise at a rate greater than overall U.S. economic growth. Government and industry have vowed to slow the growth of health care spending. Prospective payment systems using the Diagnostic Related Group (DRG) mechanism are being phased in for payment of in-patient hospital care. One expected effect of the DRG payment scheme is a more careful financial analysis of the components of surgical care. The purposes of this study were to examine a vascular procedure, ruptured abdominal aortic aneurysm (RAAA), performed at a large teaching hospital during a ten-year period; to characterize patients by cost (hospital charges exclusive of physician fees) and outcome; and to test the hypothesis that an IDENTIFIER, here the presence or absence and duration of hypotension (less than 90 mm Hg systolic), could predict differences in cost and outcome. The results, in conjunction with historic data, were used to quantify aggregate hospital expenditures for this condition by survivor and the identifier. The results indicate: (1) mortality is higher for the hypotensive patient than for the normotensive patient (p less than 0.05) and is related to the duration of hypotension; (2) lowest mean charges per patient were in the hypotensive more than thirty minutes group ($5,587) followed by normotensive ($28,298), then hypotensive less than thirty minutes ($43,876); and (3) the mean charges for each survivor were $42,447 for normotensive patients versus $107,572 for hypotensive patients.(ABSTRACT TRUNCATED AT 250 WORDS)

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“…Rupture is more common on the left side. Anterior rupture directly into the free peritoneal cavity occurs in close to 25% of patients and usually is associated with more rapid exsanguination [3,4,6,11,13,18,22]. It is important to recognize that retroperitoneal hematoma may produce marked displacement of the inferior cava, left renal vein, and duodenum [3].…”

Section: Pathologymentioning

confidence: 99%

“…Despite repeated mention in the literature [4,5,13,14,17], the importance of urgent operation in these patients continues to require emphasis. We feel it is crucial that once the diagnosis of ruptured abdominal aneurysm has been made, the patients be taken immediately to the operating room.…”

Section: Treatmentmentioning

confidence: 99%

Progress in the treatment of ruptured abdominal aortic aneurysm

et al. 1980

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This report summarizes the clinical, pathological, and surgical aspects of ruptured abdominal aortic aneurysm. The significant risk of rupture of these aneurysms is well documented. Although large aneurysms are more prone to rupture, the risk of rupture of small aneurysms less than 4 cm in diameter is well established. While most aneurysms are a result of atheroselerosis, a small number are mycotic in origin or secondary to a dissection trauma or previous aortic surgery. Rupture of abdominal aneurysms occurs into the retroperitoneum in about 3/4 of cases, and into the peritoneal cavity in the remainder. Occasionally rupture occurs into the small bowel or the inferior vena cava with fistula formation. The classical clinical features are abdominal or back pain, hypotension, and a pulsatile tender abdominal mass, but in many cases diagnosis has been delayed because of atypical presentations, in particular the absence of hypotension. Successful treatment requires immediate operation with control of the proximal abdominal aorta. Graft replacement is then performed. Avoidance of technical problems is essential, in particular damage to the great veins. Utilizing these principles we have achieved a major reduction in mortality rate in our own experience. In a series of 61 patients, overall mortality was only 14.8%. The causes of death were related to preoperative hypotension causing acute myocardial infarction, renal failure, and respiratory failure. The major factor~ responsible for these improved results were immediate operation with rapid proximal aortic control, avoidance of left thoracotomy, absence of technical errors, and expeditious completion of the surgical procedure. Despite these improved results, emphasis must continue to be placed on prevention of rupture by diagnosis and treatment of the unruptured aneurysm.The purpose of this report is to summarize the clinical, pathological, and surgical aspects of ruptured abdominal aortic aneurysm. The significant risk of rupture of an abdominal aortic aneurysm has been well documented. In the classical study of Estes [1] published in 1950, survival in a group of patients followed without surgical resection was only 18.9% at 5 years; 63.3% of deaths were due to rupture of the aneurysm. More recent reports have confirmed these findings. In a study [2] of 223 patients with abdominal aortic aneurysms that were not operated upon, the survival rate was only 54.3% at 1 year and 17.2% at 5 years, and 35% of all deaths were due to rupture of the aneurysm. In another report of 52 patients followed up without operation until all were dead, 43% of deaths at 1 year were due to rupture of the aneurysm, and by 10 years 52% of the patients had died from rupture [3].The risk of rupture has been related to the size of the aneurysm. Large aneurysms have been observed to rupture mo,'e frequently than small aneurysms. The incidence of rupture of aneurysms over 10 cm in diameter is about 6 times that of aneurysms 4 cm or under in diameter [2,3]. However, even very small aneurysms may ruptu...

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Ruptured abdominal aortic aneurysm

Cited by 33 publications

References 15 publications

Ruptured Abdominal Aortic Aneurysm Presenting as Painless Testicular Ecchymosis: The Scrotal Sign of Bryant Revisited

Ruptured Abdominal Aortic Aneurysm Presenting as Painless Testicular Ecchymosis: The Scrotal Sign of Bryant Revisited

Surgonomics: The Costs of Ruptured Abdominal Aortic Aneurysm

Progress in the treatment of ruptured abdominal aortic aneurysm

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