Aortic dissection: a case of atypical clinical manifestation and valuable lessons in management

A 55-year-old gentleman with a medical history of hypertension presented to emergency department with sudden onset of central abdominal pain and left flank pain. A CT KUB (kidney, ureter and bladder) was performed to assess the patient for a possible renal calculus and other potential gastrointestinal causes. However, an extensive aortic dissection from the arch of the aorta to the iliac arteries was detected. Hypotensive blood pressure control was started in an attempt to reduce the shear stress on the aortic wall. Unfortunately, the drop in blood pressure reduced splanchnic perfusion, resulting both duodenal perforation (secondary to duodenal ischaemia of the watershed area) and the development of acute renal failure. The patient underwent an emergency laparotomy for the perforated duodenum and biliary peritonitis. He was transferred to the intensive care unit for 18 days postsurgery for renal, respiratory, nutritional and cardiovascular support and was finally discharged home.