Kappey F, Eisen M, Strube H D
Urologe A. 1975 Nov;14(6):263-8.
18 patients were admitted from 1969 to 1973 to the Surgical and Urological University Clinic in Mainz with ruptured infrarenal aortic aneurysms. Three patients died immediately following the operation and three during surgery from internal hemorrhage. Eight patients died later following prolonged shock. Four patients survived surgery. The classical symptoms of shock, abdominal pain and pulsating tumor was only present in three patients. The diagnosis was only made in seven patients at admission, from the clinical findings. Urological symptoms were also prominent such as unilateral flank pain, colic, dysuria, anuria and tenderness over the kidney. There is no typical clinical picture of ruptured aortic aneurysm. Acute urological symptomatology in cases of acute abdomen with unclear etiology and in connection with shock could indicate a ruptured aortic aneurysm. There is absolute indication for immediate operative intervention. The aneurysm is removed and replaced by a vascular prosthesis. Early diagnosis is important since prolonged shock and anuria will result in a poor postoperative prognosis. Abdominal exploration is therefore also indicated when a ruptured aortic aneurysm is only suspected.
1969年至1973年间，18例肾下主动脉瘤破裂患者被收治于美因茨大学外科和泌尿外科诊所。3例患者术后立即死亡，3例在手术期间死于内出血。8例患者在长时间休克后死亡。4例患者手术存活。仅3例患者出现休克、腹痛和搏动性肿块等典型症状。入院时，仅7例患者根据临床表现确诊。泌尿系统症状也很突出，如单侧胁腹疼痛、绞痛、排尿困难、无尿和肾区压痛。主动脉瘤破裂没有典型的临床表现。病因不明的急腹症伴有休克时出现急性泌尿系统症状可能提示主动脉瘤破裂。立即进行手术干预有绝对指征。切除动脉瘤并用血管假体进行置换。早期诊断很重要，因为长时间休克和无尿会导致术后预后不良。因此，当仅怀疑主动脉瘤破裂时，也应进行腹部探查。
