The development of acute abdominal pain in a laboring parturient after a previous cesarean delivery is of concern and may be the result of a potentially life-threatening condition such as uterine rupture. We present a case of a parturient with type II diabetes mellitus, who had undergone 2 previous cesarean deliveries and now presented in labor with increasing abdominal pain. An emergency cesarean delivery was performed for probable uterine rupture. Intraoperatively, the patient was noted to be severely hypocarbic with significant metabolic acidosis, and the diagnosis of diabetic ketoacidosis was established.

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Aortic aneurysm rupture is typically the failure of the aortic wall to withstand the tension placed upon it by a patient’s blood pressure. Along with clinical judgement and an assessment of signs and symptoms, a computed topography angiogram (CTA) is amongst the first line of diagnostic studies having 87-94% sensitivity for rupture. Therefore, while the possibility of a CTA not catching an aortic rupture is present, the chance is very low. Usually a missed or delayed diagnosis for this type of pathology is catastrophic resulting in patient death. We present the case report of a 68-year-old male with a contained aortic rupture that was initially missed on CTA. He presented to the ED with shock like symptoms after a syncopal episode at home. Initial computed topography (CT) scan revealed a pericardial effusion with concern for hemopericardium and mass effect on the right ventricle. A follow up CTA was obtained; however, it was negative for any acute process. Given patient’s continued instability, a TTE was performed which showed concern for a dissection flap. Subsequently, a TEE was performed showing an aortic dissection at the anterior aortic root as well as severe aortic insufficiency with a perforated right coronary cusp. The patient underwent emergent cardiac surgery and recovered well despite the delay in diagnosis. This case demonstrates the importance of a high index of suspicion for acute aortic dissection despite an initial negative CTA.

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