Rose J, Civil I, Koelmeyer T, Haydock D, Adams D
Department of Vascular Surgery, Middlemore Hospital, Auckland, New Zealand.
ANZ J Surg. 2001 Jun;71(6):341-4.
Rupture of an abdominal aortic aneurysm (RAAA) carries a reported mortality rate in the range of 32-95%. Survival requires prompt diagnosis and surgical management. The presenting features, however, are varied, often insidious and potentially misleading with Osler noting nearly 100 years ago that a correct premortem diagnosis was achieved in only 33% of cases. The present study aims to review our present accuracy in diagnosing this condition and outline demographic and presenting features of patients with RAAA.
A review was undertaken of hospital and Coroner's files of all patients residing in the Auckland Coronial region who had RAAA between 1 January 1993 and 31 December 1997.
Three hundred and twenty-nine cases of RAAA were identified, and they occurred most commonly in the 8th decade. The male:female ratio was 3:1 and at least 73% of patients were Caucasian. The overall mortality was 71%. Nearly half underwent surgery and the hospital averaged mortality rate was 46%. No patient survived without surgery. Classic presenting features of RAAA were absent in many cases. Abdominal pain, back pain and a palpable mass occurred in only 49%, 36% and 18% of patients, respectively. Other common presenting symptoms included vomiting, general malaise and pelvic or hip pain. Forty-three patients (16%) were initially misdiagnosed.
Although our ability to correctly diagnose a RAAA has improved since Osler's time, the initial misdiagnosis rate of 16% leaves no room for complacency. Ruptured abdominal aortic aneurysms must be included in the differential diagnosis of any patient over the age of 55 years who presents with shock, even if the pain is non-specific or atypical.
据报道，腹主动脉瘤破裂（RAAA）的死亡率在32%至95%之间。存活需要及时诊断和手术治疗。然而，其临床表现多样，往往隐匿且可能具有误导性，正如奥斯勒在近100年前所指出的，生前正确诊断仅在33%的病例中得以实现。本研究旨在回顾我们目前对这种疾病的诊断准确性，并概述RAAA患者的人口统计学特征和临床表现。
对1993年1月1日至1997年12月31日期间居住在奥克兰验尸官辖区且患有RAAA的所有患者的医院和验尸官档案进行了回顾。
共识别出329例RAAA病例，最常见于80岁年龄段。男女比例为3:1，至少73%的患者为白种人。总体死亡率为71%。近一半患者接受了手术，医院平均死亡率为46%。无一例患者未经手术存活。许多病例中缺乏RAAA的典型临床表现。腹痛、背痛和可触及肿块分别仅出现在49%、36%和18%的患者中。其他常见的临床表现包括呕吐、全身不适以及盆腔或髋部疼痛。43例患者（16%）最初被误诊。
尽管自奥斯勒时代以来我们正确诊断RAAA的能力有所提高，但16%的初始误诊率不容自满。对于任何55岁以上出现休克的患者，即使疼痛不具特异性或不典型，腹主动脉瘤破裂都必须纳入鉴别诊断。
