INTRAABDOMINAL ACUTE DISEASES SIMULATING RUPTURE OF ABDOMINAL AORTIC-ANEURYSMS

Objective. To assess preoperative diagnosis of intraabdominal acute di seases 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 N aples, Italy. Methods. In 12 patients (8.7%) with clinical suggestion of RAAA were found other intra-abdominal acute lesions, associated wit h asymptomatic aortic aneurysm in 10 of them and absence in one; the r emainder had an intact common iliac artery aneurysm. Sonography was pe rformed in the operating room in 5 patients (41.6%) in shock, 4 hemody namically stable patients (33.3%) had CT scanning or MRI investigation s, while 3 (25%) underwent surgery directly. Interventions. Three pati ents were not operated; one half of patients were submitted to emergen cy laparotomy and in the remaining 3 patients a preoperative preparati on was made. Simultaneous aneurysm repair and nonvascular procedures w ere 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 we re done within 4 months. Results. Weight loss and fever were found at 58.3% and 50% of patients with concomitant intra-abdominal acute disea ses; both were present in 41.6%. Noninvasive imaging techniques detect ed associate lesions Ln 6 of 8 patients (75%) and absence of aneurysm in one having a bleeding adrenal mass. There were three in-hospital de aths: 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 we ight loss and fever may be suggestive of coincident lesions in patient s with suspected RAAA. Noninvasive assessment may identify associated diseases simulating aneurysmal rupture, without a delay in the treatme nt. A selective policy of medical or operative therapy may be effectiv e to minimize risk of complications and mortality rate.