Unusual presentations of urgent thoracoabdominal pain

Abstract

Introduction: Vascular emergencies in the abdomen are not common, but they are significant due to high mortality, the need for urgent diagnosis and immediate, most often operative treatment. Thromboembolic disorders lead to ischemia and infarction of the affected intra-abdominal organs, while abdominal aortic aneurysm rupture and aortic dissection, as one of the most urgent conditions in medicine, lead to hypovolemic shock and death, if not recognized in time. The aim: of this work is to point out patients with unusual clinical pictures and unexpected circumstances. With them, how not to be late with a timely diagnosis and decision on further treatment? Presentation of case 1 - female patient, aged 57, who was brought by SHMP to the Reception and Triage Clinic of the Emergency Center twice during the night: the first time due to alleged alcoholism and impaired state of consciousness, after which she was referred to the VMA, and the second time she was returned from the aforementioned institution suspected aortic dissection, when, after regaining consciousness, she complained of chest pain. After a CT aortography and a confirmed dissection of the ascending aorta, she underwent urgent surgery. The slow postoperative period with complications ended with a positive outcome, she was discharged from the hospital after 15 days. Presentation of case 2 - patient, 35 years old, who comes to the Emergency Center with severe pain in the epigastrium, which started 1 hour ago. After a suspicious ultrasound finding, elevated D-dimer and pain resistant to analgesia, a good decision was made to perform CT aortography, which indicates thrombosis of the superior mesenteric artery. He was operated on urgently, then re-operated on, and was observed by the consilium all the time, but he died on the 15th day of hospitalization. Conclusion: Unusual presentations of thoracoabdominal pain should be kept in mind, due to timely diagnosis and treatment.