MISDIAGNOSIS OF RUPTURED ABDOMINAL AORTIC-ANEURYSMS

被引:111
作者
MARSTON, WA
AHLQUIST, R
JOHNSON, G
MEYER, AA
机构
[1] UNIV CALIF SAN FRANCISCO, SAN FRANCISCO, CA 94143 USA
[2] UNIV N CAROLINA HOSP, CHAPEL HILL, NC 27599 USA
关键词
D O I
10.1016/0741-5214(92)90412-2
中图分类号
R61 [外科手术学];
学科分类号
摘要
Ruptured abdominal aortic aneurysm is a surgical emergency with a high mortality rate even when diagnosed and repaired immediately. We retrospectively reviewed 152 cases of ruptured abdominal aneurysms to identify the incidence of misdiagnosis leading to a delay in treatment, the most frequent misdiagnoses, and the outcome in this group of patients. Forty-six (30%) were initially misdiagnosed. The most common misdiagnoses were renal colic, diverticulitis, and gastrointestinal hemorrhage. The most common initial physical findings in misdiagnosed patients were abdominal pain (70%), shock (57%), and back pain (50%). A pulsatile abdominal mass was found in only 26% of misdiagnosed patients versus 72% of patients correctly diagnosed (p < 0.005). Misdiagnosed ruptured abdominal aneurysm had a 44% mortality rate, which was not significantly different from patients correctly diagnosed (58%,p = 0.34). The lack of difference in mortality rates is most likely due to preselection of those misdiagnosed patients who were able to withstand the delay in diagnosis and survive to surgical treatment. The 30% incidence of misdiagnosis in this series suggests that it is frequently a difficult diagnosis to make and must be considered in elderly patients, especially men, who are admitted with abdominal pain and/or back pain.
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页码:17 / 22
页数:6
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共 22 条
  • [1] RUPTURED ABDOMINAL AORTIC-ANEURYSM - THE TACOMA EXPERIENCE
    BODILY, KC
    BUTTORFF, JD
    [J]. AMERICAN JOURNAL OF SURGERY, 1985, 149 (05) : 580 - 582
  • [2] CHANDLER JJ, 1984, NEW ENGL J MED, V310, P1538
  • [4] GRABOWSKI EW, 1981, AM SURGEON, V47, P311
  • [5] HOFFMAN M, 1982, SURGERY, V91, P597
  • [6] JOHNSON G, 1980, ARCH SURG-CHICAGO, V115, P51
  • [7] JOHNSON G, 1985, ARCH SURG-CHICAGO, V120, P1138
  • [8] PERFORATION OF THE PULMONARY-ARTERY WITH SWAN-GANZ CATHETERS - DIAGNOSIS AND SURGICAL-MANAGEMENT
    KELLY, TF
    MORRIS, GC
    CRAWFORD, ES
    ESPADA, R
    HOWELL, JF
    [J]. ANNALS OF SURGERY, 1981, 193 (06) : 686 - 692
  • [9] THE VALUE OF COMPUTED-TOMOGRAPHY IN THE MANAGEMENT OF SYMPTOMATIC ABDOMINAL AORTIC-ANEURYSMS
    KVILEKVAL, KHV
    BEST, IM
    MASON, RA
    NEWTON, GB
    GIRON, F
    [J]. JOURNAL OF VASCULAR SURGERY, 1990, 12 (01) : 28 - 33
  • [10] LAWLER M, 1984, SURGERY, V95, P38