Six elderly male patients (mean age, 73 years; range, 66 to 78 years) were admitted with groin masses caused by ruptured abdominal aortic aneurysms. A palpable abdominal mass was present in 33%. All patients eventually underwent abdominal aortic aneurysmectomy with a resultant mortality rate of 50%. Delayed diagnosis, preoperative hypotension, advanced age, poor nutritional status, and excessive intraoperative blood loss were factors contributing to this high mortality rate. In this unusual clinical presentation of ruptured abdominal aortic aneurysm, a high index of suspicion by the emergency room staff and prompt surgical intervention are mandatory to improve mortality rates. The anatomy of the retroperitoneal space and the phylogenetic development of a channel between the scrotum and the kidney are important factors in the development of this symptom complex.