ABDOMINAL AORTIC ANEURYSM

Clinical presentation

• Unremitting

• Lumbar back pain
• Flank pain
• Groin pain

(Abdominal pain without back pain is rarely leaking AAA)

• Cardiac arrest

• Unexplained Hypotension

N.B. beware of > 50 y.o with 'renal colic'

Investigation

• Urgent bedside U/S (unstable patient with abdominal/back pain, unreliable abdominal examination and reasonable diagnostic uncertainty)

N.B. ultrasound confirms aneurysm but not leakage

• Urgent CT abdomen (stable patient with abdominal/back pain with unreliable abdominal examination findings or ultrasound findings)

N.B. Urgent CT mandated even after hours

Management

Resuscitation

• Two > 16 G cannula
• Minimimal (hypotense) fluid resuscitation if unstable [aim to maintain SBP no greater than 80-100mmHg]
• Careful use of titrated IV opiate analgesia
• Immediate arrangements to transfer to theatre or theatre recovery
• Inform anaesthetic registrar and theatre
• Crossmatch 10 units of blood (warn transfusion lab)
• Inform ICU

Immediate laparotomy

• Pain in unstable patient  with known AAA (CT or US not required prior to laparatomy)
• Pain in unstable patient with AAA, newly diagnosed on ultrasound
• Stable patient with CT confirming leaking AAA

Operative Mortality

Asymptomatic non-leaking AAA (10%)
Symptomatic non-leaking AAA (23%)
Ruptured AAA (90%)

Adapted from Memo 9/4/02 by Dr Ian Spark (TQEH Vascular Consultant)