Unoperated ruptured abdominal aortic aneurysms: a retrospective clinicopathological study over a 10-year period.

A series is described of 41 cases of unoperated ruptured abdominal aortic aneurysm in 9894 consecutive autopsies performed in two large general hospitals in Glasgow between 1964 and 1974. The preceding clinical presentations are discussed. These show the difficulaties in diagnosing the condition correctly and quickly and the liability to confusion with other intra-abdominal conditions. The correct diagnosis was established before death in only 11 cases, it was suspected in 6 cases and was completely missed in 24 cases. Pathologically, all the cases were atheromatous and measured more than 5 cm in diameter, and the most common site of rupture was through the lateral wall. Resection would appear to have been technically possible without undue difficulties in the majority of the cases. An analysis of all the findings indicates the necessity for greater clinical awareness of this condition and its variable mode of presentation. Only in this way will early diagnosis and safer surgical intervention be possible.