A 60-year-old man presents with a pulsatile abdominal mass, severe back pain, and hypotension. Which of the following is the MOST appropriate immediate management?

• A Emergency CT angiography to confirm rupture before surgery
• B Resuscitate with 2 L crystalloid and re-evaluate in 30 minutes
• C EVAR in the hybrid theatre if immediately available
• D Immediate transfer to operating theatre for emergency repair without CT ✓

Explanation

A symptomatic/ruptured AAA (pulsatile mass + back pain + haemodynamic instability) is a surgical emergency with mortality >50% without immediate intervention. In a haemodynamically unstable patient, CT is contraindicated as it delays surgery and the patient may arrest in the scanner. Transfer directly to the operating room for emergency repair (open or EVAR if immediately and quickly available with an experienced team). The goal is minimal delay from diagnosis to haemostasis.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.