A Case of Acute Aortic Dissection Complicated by Bowel Malperfusion

Area of Science:

• Cardiology
• Vascular Surgery
• Emergency Medicine

Background:

• Acute aortic dissection (AAD) is a critical medical emergency with high mortality.
• Early diagnosis and intervention are vital for patient outcomes.
• Typical presentations involve acute chest pain, but atypical symptoms can obscure diagnosis.

Observation:

• A 57-year-old male presented with cognitive disorientation, abdominal pain, nausea, vomiting, diarrhea, and elevated lactate levels.
• Initial imaging revealed no acute findings, but cocaine use and elevated lactate prompted further investigation.
• Computed tomography angiography identified an abdominal aortic dissection with extrinsic compression of the true lumen.

Findings:

• The patient was diagnosed with a Type A aortic dissection and extensive bowel ischemia.
• The dissection's atypical presentation complicated initial diagnosis.
• The patient was deemed too unstable for surgical intervention and subsequently expired.

Implications:

• This case underscores the diagnostic challenges posed by varied AAD presentations, particularly in patients with altered mental status.
• Maintaining a high index of suspicion for AAD in high-risk individuals is crucial.
• Recognizing potential complications, such as bowel ischemia, is essential for timely management.