To the Editor.—In the March 1984 issue of the Archives, Louras and Welch reported two cases of ruptured abdominal aortic aneurysms that were diagnosed as acute incarcerated inguinal hernias.1 The authors made the point that ruptured aortic aneurysms may have unusual clinical manifestations. However, they failed to mention that any acute or chronic intra-abdominal disease or catastrophe can manifest itself as an acutely incarcerated external hernia, in what is sometimes referred to as a "symptomatic hernia." We published a series of such cases in 1972,2 and since then have treated many more such patients.
The aggravation or strangulation of previously asymptomatic or unrecognized hernias is occasionally the result of increased intra-abdominal pressure due to an accompanying acute or chronic intra-abdominal disease. These hernias carry a high mortality because preoperative diagnosis is difficult. Only the awareness of the staff and residents that an intra-abdominal catastrophe of any sort