RUPTURED ABDOMINAL AORTIC-ANEURYSM AS INC IDENTAL CAUSE IN EMERGENCY LAPAROTOMY FOR ACUTE ABDOMINAL SYMPTOMS

The ruptured abdominal aortic aneurysm as an incidental finding in eme rgency laparotomy for acute abdominal symptoms is a rare event. For th is reason it is more important to know the necessary diagnostic and th erapeutic strategies. Nowadays sonography facilitates the preoperative diagnosis. The performance of an additional computed tomography or an giography depends on the clinical appearance of the patient, hn hemody namically instable patients with a ruptured aneurysm, an immediate lap arotomy is mandatory. If intraoperatively the aortic aneurysm has a di ameter of more than 5 cm arid shows no signs of rupture, implantation of an aortic prosthesis is indicated. This procedure has also priority when patients with a ruptured aneurysm are suffering from an addition al abdominal disease. If additional septic reasons are diagnosed intra operatively the abdominal operation has to be performed synchronously with the aortic prosthesis, Alternatively, the use of an antimicrobial vascular prosthesis or resection of the aortic aneurysm with extra-an atomic bypass has to be considered. The technical difficulty of the op eration is in the control of the proximal aorta. The lethality of oper ations for ruptured aneurysm has been consisted high (between 21 and 7 0 %) in the past, In an elective operation, mortality has how improved up to 5%. This indicates that the essential prognostic factors, degre e of retroperitoneal hematoma and hemorrhagic shock, and the condition of the patient, are not influenced by modern patient management. Howe ver, a further dominant prognostic parameter for lethality, how qualif ied the surgeon is in vascular surgery, can be influential.