Ruptured abdominal aortic aneurysm is potentially life threatening. Ruptured aortic aneurysm causes internal bleeding that could lead to serious complications like heart attack, stroke and deprivation of blood to the colon or spinal cord and eventually death. The mortality rate is extremely high in this condition.
The symptoms of ‘AAA’ are asymptomatic. They become known only through ultrasound or computed tomography scan (CT scan) ordered for examination of other aliment, through sudden onset of severe symptoms, rupture or through initial screening of abdominal aortic aneurysm done under Medicare program. Men particularly between 65 to 75 years age are vulnerable to ‘AAA’. Hence, it is imperative to take a referral for ‘AAA’ screening under Medicare part B from a physician. ‘AAA’ is an emergency and requires immediate medical attention.
A ruptured abdominal aortic aneurysm sign is sudden excruciating pain in the abdomen and back, pulsating abdominal mass and hypotension. The patient might faint; vomit and the skin will feel cold and clammy. Such patient should be rushed to the hospital immediately. Once the patient reaches the hospital it is important to perform an urgent ultrasound or computed tomography scan. However, in most cases only X-ray or ultra sonography is possible due to paucity of time.
The initial X-ray results usually reveal an aneurysm that is grown over 50% its normal size due to calcification, hemorrhage and clearly visible stretched base of the aorta. The doctor will be able to decipher a pulsatile mass to the left side of the abdomen, just little away from the umbilicus, reduced inferior extremity pulses and abdominal systolic bruit. The internal bleeding that happens due to rupture can cause severe irritation in the peritoneal area. The peritoneal area is a thin serous membrane that lines the walls of the abdominal cavity and envelops the entire viscera.
Types of ruptured abdominal aortic aneurysm:
Retroperitoneal – Accumulation of blood is found in the retroperitoneal hematoma (an anatomical gap in the abdominal cavity that is situated behind the peritoneum (gut cavity). About 80% of abdominal aortic aneurysm cases reported have been caused due to retroperitoneal rupture.
Intraperitoneal- The rupture occurs within the peritoneum. About 20% reported abdominal aortic aneurysm cases are caused due to intraperitoneal rupture. In this situation, there are no tissues present to restrain the break out of blood from the aorta unlike in retroperitoneal rupture. Hence, the mortality rate is higher in intraperitoneal rupture cases.
Chronic- Chronic rupture is rare and occurs in a confined anatomical area and the surrounding tissues contain the blood leak. Chances of survival are higher in this case.
Rupture into vena cava inferior-Vena caval is the vein that carries oxygenated blood from lower part of the body to the right atrium of the heart. Sometimes the ‘AAA’ wears down the adjoining vena cava inferior that leads to formation of aortacaval fistula that grows in size and eventually ruptures. Compression of inferior vena cava can result in high output heart failure or peripheral edema.
Rupture into duodenum- Duodenum is a portion of small intestine that stretches from stomach to jejunum. An aortoduodenal fistula formation in the duodenum bursts open causing gastrointestinal bleeding.
Ruptured abdominal aortic aneurysm is treated through open surgery or endovascular surgery. The aneurysm is cleaned and the void space is replaced with a graft that is sewn from one end of the aorta to the other covering the void space. Endovascular surgery is less invasive compared to open surgery. There is risk of blood clots, hypotension, shock and other complications during the surgery. Considering severity of the condition, existing medical issues and other risks involved which type of surgery is to be undertaken is decided. It is important to remember a ruptured abdominal aortic aneurysm is an acute condition. Thus requires prompt medical attention as it may occur suddenly owing to the symptoms being asymptomatic.