Localized dissection and delayed rupture of the abdominal aorta after extracorporeal shock wave lithotripsy

Extracorporeal shock wave Lithotripsy (ESWL) represents the preferred treat ment for most upper ureteric and renal calculi. Complication rates associat ed with ESWL are ion; justifying the enthusiasm and acceptance of this trea tment modality. As the technique has become more widely available, some del eterious effects on the kidneys and the surrounding tissues are increasingl y recognized. We report on the rupture of a severely calcified abdominal ao rta in a 65-year-old man who underwent 3 months of ESWL treatment earlier f or renal calculi. The patient was seen with an acute recrudescence of a lon g-standing abdominal and left flank pain, which began immediately after the last of the three sessions of ESWL and was associated with an episode of h ypotension that occurred an hour before admission. Patient history and chro nologic course of events strongly suggest the role of ESWL in the genesis o f abdominal aorta rupture.