Coroner's Finding: Skrepetos, Stavroula

80y · Female·Haemoperitoneum/retroperitoneal haematoma due to rupture of the abdominal aorta secondary to ruptured infra-renal abdominal aortic aneurysm caused by generalised atherosclerosis

An 80-year-old woman presented to hospital after falls causing head injury and cervical spine fracture. Initial CT ruled out intracranial pathology. She developed undifferentiated shock at 5am, initially attributed to sepsis and treated with fluids and antibiotics. She appeared to stabilize but deteriorated further at 11am with severe hypotension, severe anaemia, and metabolic acidosis. Resuscitation failed and she died. Autopsy revealed a ruptured infra-renal abdominal aortic aneurysm with massive haemoperitoneum and retroperitoneal haematoma. The aneurysm had been documented in 2011 but no follow-up records exist. The coronial medical consultant found the haemorrhage was not medically predictable and diagnosis of occult arterial bleeding in undifferentiated shock is diagnostically challenging. Medical care was considered conscientious; prognosis was poor even with earlier diagnosis.