Intra-abdominal acute diseases simulating rupture of abdominal aortic aneurysms

Objective. To assess preoperative diagnosis of intraabdominal acute diseases manifesting as a RAAA and determine treatment options. Design. Retrospective review, with a mean follow-up period of 4 years. Setting. Vascular Department, Medical School, University "Federico II" of Naples, Italy. Methods. In 12 patients (8.7%) with clinical suggestion of RAAA were found other intra-abdominal acute lesions, associated with asymptomatic aortic aneurysm in 10 of them and absence in one; the remainder had an intact common iliac artery aneurysm. Sonography was performed in the operating room in 5 patients (41.6%) in shock, 4 hemodynamically stable patients (33.3%) had CT scanning or MRI investigations, while 3 (25%) underwent surgery directly. Interventions. Three patients were not operated; one half of patients were submitted to emergency laparotomy and in the remaining 3 patients a preoperative preparation was made. Simultaneous aneurysm repair and nonvascular procedures were performed in 4 patients; nonvascular operations alone were carried out in 5 patients. 4 patients underwent a successful later treatment of their aneurysms: two aneurysmectomy and two endoluminal stenting were done within 4 months. Results. Weight loss and fever were found at 58.3% and 50% of patients with concomitant intra-abdominal acute diseases; both were present in 41.6%. Noninvasive imaging techniques detected associate lesions Ln 6 of 8 patients (75%) and absence of aneurysm in one having a bleeding adrenal mass. There were three in-hospital deaths: one patient died of metastatic disease without operation and two after surgery (22.2%). Two late deaths from cancer cachexia occurred at 11 months and 3.6 years. Conclusions. Atypical findings, such as weight loss and fever may be suggestive of coincident lesions in patients with suspected RAAA. Noninvasive assessment may identify associated diseases simulating aneurysmal rupture, without a delay in the treatment. A selective policy of medical or operative therapy may be effective to minimize risk of complications and mortality rate.