An uncommon cause of acute abdomen: Aortic dissection complicated by superior mesenteric artery occlusion

Abstract

A 78-year-old-man with a history of hypertension, an old cerebrovascular accident, chronic obstructive pulmonary disease (COPD) presented with severe epigastric pain for 1 h and was admitted through the emergency department (ED). The pain was a dull ache in character, did not radiate, and was not associated with fever, diarrhea or a tarry or bloody stool. He had had no abdominal surgery before. The physical examination at the ED showed epigastric tenderness but without rebounding tenderness. The plain X-ray abdomen revealed the ileus of the small intestine. His abnormal laboratory tests included a mild leukocytosis, white blood cell count of 12 000 mm 3 (normal range: 6000-10 000 mm 3 ), blood urea nitrogen of 75 mg/dL (normal range: 7-22 mg/dL), creatinine of 2.8 mg/dL (normal range: 0.3-1.5 mg/dL). The liver function, amylase and lipase were all within normal limits. Abdominal computed tomography (CT) Figure 1 revealed gas in the intestinal wall (pneumatosis intestinalis) indicating intestinal necrosis. As shown in the CT Figures 2 and 3 showed a superior mesenteric artery occlusion due to aortic dissection (Stanford type B). During the operation, ischemic necrosis of the small intestine from the ligament of Treitz to the descending colon was found. The patient died of sepsis on the 2nd day. DISCUSSIONThe common causes of superior mesenteric artery (SMA) ischemia are embolism (50%), thrombosis (25%) and non-occlusive mesenteric ischemia (20%).1 In aortic dissection, only 3-5% of cases are found to be complicated by an SMA occlusion. 2,3There are idiopathic and secondary types of pneumatosis intestinalis 4 . Intestinal necrosis is the most common

A case report of unexpected sudden cardiac death due to aortic rupture following laparoscopic appendectomy

“…[ 14 ] Classical symptom of aortic dissection is usually sudden chest pain or back pain, but they are atypical and nonspecific symptoms of aortic dissections. In several reported case reports, presenting symptom of aortic dissection was acute abdominal pain, [ 15 – 17 ] but its incidence was rare (4.6%) by Upchurch et al [ 18 ]…”