When the Aorta Deceives: A Type A Dissection Case Masquerading as Limb Ischemia and Fecal Incontinence

TL;DR

A 55-year-old man with chest pain, limb ischemia, and fecal incontinence was diagnosed with a severe aortic dissection, highlighting the need for quick recognition of unusual symptoms.

Contribution

This case emphasizes the atypical presentation of aortic dissection with gastrointestinal and limb ischemia symptoms.

Findings

Aortic dissection was diagnosed via CT aortography despite non-specific symptoms.

The dissection extended from the aortic annulus to the iliac arteries.

Prompt surgical intervention was critical for a favorable outcome.

Abstract

A 55-year-old hypertensive male and chronic smoker presented with sudden severe central chest pain accompanied by excruciating left lower-limb pain and episodes of non-bloody diarrhea associated with fecal incontinence. Examination revealed a cold, clammy right upper limb and left lower limb with diminished peripheral pulses but no neurological deficits or abdominal tenderness. CT aortography demonstrated a Stanford Type A aortic dissection extending from the aortic annulus to the iliac arteries. The patient was stabilized and then transferred for emergent open surgical repair. Aortic dissection is an acute cardiovascular emergency characterized by an intimal tear in the aortic wall, allowing blood to dissect between the intima and media, compromising flow to vital organs. It is associated with exceedingly high morbidity and mortality rates. It is commonly associated with uncontrolled hypertension, connective tissue disorders, and atherosclerosis. This case highlights the importance of urgent management and early recognition of atypical manifestations, such as gastrointestinal symptoms and limb ischemia in acute aortic dissection, to enable rapid surgical intervention and favorable outcomes.

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