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Ruptured AAA — RACP Adult Medicine MCQ

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ModerateEmergency MedicineRuptured AAARACP Adult Medicine

A 70-year-old man with known abdominal aortic aneurysm (5.8 cm) on surveillance presents with acute onset severe back pain and haemodynamic instability (BP 80/50 mmHg). What is the immediate priority?

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Correct answer: E — Emergency surgical or endovascular repair

A known large AAA with sudden onset back pain and haemodynamic instability is a ruptured AAA until proven otherwise. This is immediately life-threatening with mortality >80% if untreated. The priority is emergency surgical repair (open or endovascular). Permissive hypotension (SBP 70–80 mmHg) is preferred over aggressive fluid resuscitation (which increases bleeding). CT may be performed only if the patient is haemodynamically responsive and the diagnosis is uncertain. Time to operating theatre is the key determinant of survival.

Reference: eTG – 2025 – Cardiovascular; CSVS – 2024 – AAA Emergency Guidelines