Ruptured abdominal aortic aneurysm secondary to delayed management owing to coronavirus disease infection: A case report

Abstract

An 81-year-old man developed altered level of consciousness, and an ambulance was summoned. For this case situation, the doctor car was dispatched to the patient’s home. His family member was diagnosed with coronavirus disease 2019 (COVID-19) 4 days prior to his presentation; however, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction test showed a negative result in the patient. Upon arrival at the scene, he developed shock with fever, and his quick sequential organ failure assessment score was 3. We diagnosed the patient with COVID-19-induced septic shock, and prehospital management including endotracheal intubation followed by mechanical ventilation, fluid resuscitation, and vasopressor administration was initiated. Despite multiple attempts, no hospital accepted the patient, and he was eventually transferred to our hospital; the time interval between arrival at the scene and departure from the scene was 57 min. Upon admission, he remained in shock, and the SARS-CoV-2 antigen test showed a positive result. Laboratory test results showed severe anemia. A plain chest radiograph revealed reduced radiolucency in a part of the left lower lung field; however, no sign of pneumonia was evident. Plain abdominal computed tomography revealed dilatation of the abdominal aorta (92 mm in maximal diameter) with an extensive retroperitoneal hematoma. The patient was diagnosed with hemorrhagic shock secondary to ruptured abdominal aortic aneurysm. Palliative care was initiated after informed consent was obtained from the family; unfortunately, the patient died 6 hours after admission. Careful evaluation is essential for prompt and accurate prehospital diagnosis in patients with suspected severe COVID-19 infection.