When Abdominal Pain Hides the Truth: Aortic Dissection Presenting as Paralytic Ileus

TL;DR

Aortic dissection can mimic bowel obstruction symptoms, leading to misdiagnosis, as shown in a case where a patient presented with abdominal issues instead of typical chest or back pain.

Contribution

This case report highlights an atypical presentation of aortic dissection as paralytic ileus, expanding diagnostic awareness.

Findings

Aortic dissection was diagnosed in a patient presenting with constipation and abdominal bloating, not typical chest or back pain.

Contrast-enhanced CT scan confirmed Stanford type B aortic dissection despite initial suspicion of bowel obstruction.

The case emphasizes the need to consider aortic dissection in differential diagnoses for ileus, especially in patients without traditional risk factors.

Abstract

Aortic dissection is often characterized by severe chest or back pain, but it can present atypically, leading to diagnostic challenges. This case report highlights an unusual presentation of Stanford type B aortic dissection in a patient with gastrointestinal symptoms. A 68-year-old male patient with no prior abdominal surgical history presented with a seven-day history of constipation and abdominal bloating. Initial assessments suggested bowel obstruction, supported by physical examination and abdominal X-ray findings. However, a contrast-enhanced abdominal computed tomography (CT) scan revealed an intimal flap at the T10-L1 level with an associated intramural hematoma, confirming a diagnosis of Stanford type B aortic dissection. This case underscores that aortic dissection can present with symptoms consistent with paralytic ileus.Physicians should include aortic dissection in the differential diagnosis of patients presenting with ileus, particularly those with no prior surgical history or who have never been diagnosed with conditions such as difficult-to-control hypertension, giant cell arteritis, bicuspid aortic valve, intracranial aneurysms, simple renal cysts, a family history of aortic disease, or Marfan syndrome.

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