Ruptured abdominal aortic aneurysm presenting as buttock pain

Area of Science:

• Vascular Surgery
• Diagnostic Radiology
• Geriatric Medicine

Background:

• Abdominal aortic aneurysms (AAAs) are serious vascular conditions.
• Ruptured AAAs typically present with severe abdominal or back pain, hypotension, and pulsatile abdominal mass.
• Atypical presentations of AAA rupture are uncommon but can complicate diagnosis.

Observation:

• An 80-year-old male presented with acute right buttock pain, an unusual symptom for ruptured abdominal aortic aneurysm.
• Literature review identified limited cases of aneurysmal pain presenting in the hip or buttock region.
• Previous reports included a ruptured internal iliac artery aneurysm with hip pain and an unruptured AAA with chronic hip pain.

Findings:

• The patient's acute buttock pain was the primary presenting symptom of a ruptured abdominal aortic aneurysm.
• This case represents a rare clinical manifestation of AAA rupture, differing from typical presentations.
• Diagnostic challenges arise when symptoms deviate from classic patterns, necessitating a broad differential diagnosis.

Implications:

• Highlights the importance of comprehensive patient history and physical examination in diagnosing complex vascular emergencies.
• Emphasizes maintaining a high index of clinical suspicion for aneurysm rupture in elderly patients, especially those with a history of collapse.
• Suggests that buttock or hip pain can be a presenting symptom of ruptured abdominal aortic aneurysm, requiring prompt investigation.