Transperitoneal approach should be considered for suspected ruptured abdominal aortic aneurysms.

Although transperitoneal surgical repair has been the gold standard for patients with a suspected ruptured abdominal aortic aneurysm (rAAA), the retroperitoneal approach and endovascular aortic repair (EVAR) are increasingly being recommended as preferred approaches due to lower morbidity and mortality. To highlight the importance of considering the transperitoneal approach, we present three cases of suspected rAAA, all with a known AAA, who were found to have other significant intra-abdominal pathology at surgery that would have been missed using the other approaches.