A patient over 60 years old presents with severe back and abdominal pain, syncope, and a tender pulsatile abdominal mass. What is the likely diagnosis?

The scenario presented describes a patient with several key features that strongly suggest a ruptured abdominal aortic aneurysm (AAA). The patient's age, over 60 years, is significant, as the risk for aneurysms increases with age, particularly in men and individuals with certain risk factors such as hypertension or a history of smoking.

The severe back and abdominal pain, along with syncope, can be attributed to the acute nature of a rupture. The pain associated with a ruptured AAA is often described as severe and tearing, often radiating to the back, which corresponds to the symptomatology in this case. Syncope may occur due to rapid blood loss leading to decreased perfusion and transient loss of consciousness, which is a critical sign of impending shock.

Additionally, the presence of a tender pulsatile abdominal mass is highly indicative of an AAA. This physical finding suggests that the aneurysm is not only present but is also likely rupturing, given the acute symptoms of pain and syncope.

In contrast, other conditions like cholecystitis, pancreatitis, and kidney stones typically present with different pain patterns and additional symptoms. Cholecystitis often causes pain in the upper right quadrant and may be associated with fever, while pancreatitis