Ruptured abdominal aortic aneurysm: initial misdiagnosis and the effect on treatment.

OBJECTIVE: To evaluate the incidence of misdiagnosis in ruptured abdominal aortic aneurysm and its effect on treatment and outcome.

DESIGN: Retrospective study.

SETTING: Teaching hospital, The Netherlands.

SUBJECTS: 97 consecutive patients admitted with ruptured abdominal aortic aneurysm during the 5-year period, 1 January 1989--31 December 1993.

MAIN OUTCOME MEASURES: Initial diagnosis, interval between onset of symptoms and admission, and mortality.

RESULTS: 38 Patients (43%) presented with symptoms of their aneurysm exceeding nine hours prior to admission (range 10 hours to 14 days, median 2 days). Fifty patients (60%) were initially misdiagnosed by the referring practitioner. Ultrasonography was consistent with rupture in only 36/70 (51%). 52 Patients died (54%), (operative mortality 45 (46%)), and was not affected by delay in diagnosis or treatment.

CONCLUSIONS: Although delay in diagnosis or treatment did not seem to affect mortality, improved awareness of non-specific presentations of (imminent) rupture will result in fewer misdiagnoses and earlier treatment. A group of patients will undoubtedly benefit from this as they can be operated on at a stage when expected mortality is lower.