Diagnosis and perioperative management of ruptured AAA mimicking symptomatic groin hernia

• RAAA presenting as symptomatic groin hernia has poor survival.
• CTA for diagnosis and preoperative planning is strongly recommended.
• Hypotensive haemostasis lowers mortality.
• Coinciding inguinal hernias should not be repaired at the same time.

IntroductionRuptured abdominal aortic aneurysm (RAAA) can infrequently present as symptomatic groin hernia. This misleading form of presentation often leads to erroneous preoperative management resulting in poor survival.Case presentationTwo patients with RAAA mimicking symptomatic groin hernia underwent different preoperative managements pointing out the importance of the principles of hypotensive haemostasis in the scope of this emergency scenario.ConclusionComputed Tomography Angiography (CTA) remains the recommended diagnostic tool—for both safe diagnosis of the ruptured aneurysm and precise preoperative planning. Endovascular aortic repair of the RAAA—if feasible—is the treatment of choice. This rare form of RAAA manifestation should call physicians attention—especially in patients with known abdominal aortic aneurysms in their preceding medical history.