Abdominal aortic aneurysm rupture masquerading as strangulated inguinal hernia

Groin Swelling, the Anatomic Way Out of Abdominal Haematomas: a Case Report and Explicative Literature Review

“…Ruptured abdominal aortic aneurysm has been reported to be present in a similar Fig. 1 The patient's inguinal swelling manner (4,5). On the other hand, a non-specific retroperitoneal haemorrhage has been reported as being present in the inguinal canal, giving the appearance of a strangulated hernia (6).…”

“…One can imagine that when a hernia exists, the accumulation continues into the hernia (but outside the hernia sac) and in males to the scrotum. The above mentioned mechanism seems to explain the 14 cases of aortic aneurysm rupture (4,5) and the two cases involving pancreatic fluid (7,8). At inguinal exploration, a fluid-filled bluish indirect hernia sac was identified and found to be contoured by free flowing, nonclotting blood.…”

Inguinal herniae: Valuable clues to concurrent abdominal pathology

“…1,2 However, the presence of blood/haematoma in the inguinal canal should alert the surgeon to the possibility of significant intra-abdominal haemorrhage and prompt investigation is required to avoid poor outcome. 1 In general, atypical tissues and fluid encountered during elective or emergency hernia repair should always be sent for histological and cytological evaluation. Failure to do so can result in late presentation of concurrent abdominal pathology.…”

Ruptured Ectopic Pregnancy Presenting as an Irreducible Inguinal Hernia

“…Some of the distant potential sources of a haematoma within a hernia sac include a ruptured abdominal aortic aneurysm (RAAA), splenic rupture and non-specific retroperitoneal haemorrhage (1,(9)(10)(11). These are uncommon presentations of a symptomatic hernia and a high index of suspicion is required to make a diagnosis (1).…”

“…These are uncommon presentations of a symptomatic hernia and a high index of suspicion is required to make a diagnosis (1). RAAA and splenic haemorrhage are known to have delayed or atypical presentation which may initially seem benign until the onset of hypotension (1,9,10) Retroperitoneal haemorrhage may present as blood in the inguinal canal simulating a strangulated hernia. Misdiagnosis in these patients often results in inadequate resuscitation and delayed surgery resulting in a higher risk of mortality (2).…”