Images in clinical medicine a case of ruptured abdominal aortic aneurysm.

A Case of Ruptured Abdominal Aortic Aneurysm

This is a case of a 46-year-old male presented to the emergency department with abdominal pain radiated from the loin to the groin: “typical renal colic description”. His past medical history included nephortic syndrome (minimal change glomerulonephropathy). On examination, he was very obese (BMI of 40.0). His pulse rate was 120 beats per minute and blood pressure was 100/70 mmHg on the right arm and 70/50 mmHg on the left arm. The abdomen was tender all over but there was no rigidity or palpable mass. Laboratory investigations showed Urea of 20.4 mmol/l and creatinin of 300 µmol/l. Abdominal ultrasound was very difficult due to his morbid obesity. Urgent abdominal CT scan (figure 1) showed an infra renal aortic aneurysm 6.2 cm in diameter with evidence of leakage. There was a haematoma in the left psoas muscle and in the mesenteric fat around the left side of the aorta. The patient was taken to the theatre for an urgent aneurismal repair. He was transferred to the intensive care unit. Unfortunately, the patient died after 21 days due to sepsis and multi-organ failure.

Figure 1

CT showing the presence of intramural hematoma. There is para-aortic leak which indicates impending rupture.

Learning points

Ruptured aortic aneurysm (RAA) may present with typical renal colic [1].

High index of suspicion is needed to make the diagnosis of RAA due to lack of the classic presentations in some cases [2].