LAPAROTOMY FOR PRESUMED RUPTURED ABDOMINAL AORTIC-ANEURYSM - OUTCOME OF DECEPTIVE EMERGENCIES

Medical and surgical emergencies occasionally present as ruptured abdo minal aortic aneurysms (RAAA). To assess benefits of laparotomies and adverse effects of unnecessary operations, the authors reviewed their experience. Thirteen patients, 9 women, 4 men (mean age: 72 years, ran ge: 41-85) underwent emergency laparotomy between 1988 and 1996 for pr esumed RAAA and were found to have other surgical or medical emergenci es. All the patients presented with hypotension, 12 had abdominal or b ack pain, four had pulsatile abdominal mass. Rupture was not excluded by computed tomography scan in three or by ultrasonography in two pati ents. Laparotomy disclosed intact abdominal aorta in all, but seven pa tients had abdominal aortic aneurysm. Of five surgical emergencies, la parotomy was indicated in four: three for ruptured visceral artery ane urysms, one for perforated duodenal ulcer. The fifth patient required thoracotomy for ruptured thoracic aneurysm. Four of eight medical emer gencies were myocardial infarctions. One iatrogenic complication requi red reoperation for bleeding. Mean hospital stay was 18 days; mean hos pital charges were $40,771. Seven (54%) early deaths occurred; none we re caused directly by the operation. Laparotomy was indicated in one t hird of deceptive emergencies that present as RAAA. Although mortality , morbidity, and costs were high, iatrogenic surgical complications we re rare and deaths were not caused by unnecessary operations.