Acute aortic dissection masquerading as large bowel obstruction: a case report

Acute aortic dissection (AD) is a life-threatening disorder. A significant diagnostic pitfall is its ability to mimic an acute surgical abdomen, particularly in Stanford type B dissections. The aim of this report is to underscore the lifesaving step of appropriate imaging to probe the vascular integrity of the aorta before surgical intervention in a hypertensive patient that presented with classic features of large bowel acute intestinal obstruction.

A 50-year-old hypertensive male presented with a one-week history of constipation, abdominal distension, and colicky pain, initially diagnosed as large bowel obstruction. Cardiologist review was requested due to persistent severe hypertension. Further evaluation with a contrast-enhanced CT imaging revealed an extensive Stanford type B (DeBakey type IIIb) aortic dissection involving the arch and abdominal aorta. The patient was managed conservatively with parenteral labetalol and opioid analgesics before transfer to a facility of his choice.

In the setting of acute abdomen and severe hypertension, imaging to probe the vascular integrity of the aorta is essential to avoid life-threatening, inappropriate surgical interventions. The primary "take-away" lesson is the need for high suspicion of AD in hypertensive patients with abdominal symptoms.