The misdiagnosis of ruptured abdominal aortic aneurysm: an ancient problem always present. Report of an atypical case.

The rupture of an abdominal aortic aneurysm is one of the most dramatic event in the daily clinical practice. It is often easily suspected when the classical signs of hemorrhagic shock are associated with an anterior (mesogastric) abdominal pain and an expanding mass, especially in the non-obese patients. Sometimes many of these signs can lack and, as a consequence, the diagnosis might be very difficult. This may cause a fatal delay for the patients. We describe a singular case in which the rupture of an abdominal aortic aneurysm was simulating an acute cholecystitis: the presented symptoms, together with a negative personal medical history, were so atypical that even four experienced practitioners misdiagnosed the vascular lesion and the diagnosis was possible only at autopsy.