A Case of Acute Aortic Dissection Complicated by Bowel Malperfusion.

Acute aortic dissection (AAD) is a life-threatening condition with high mortality rates. Prompt diagnosis and intervention are crucial to minimize complications; high suspicion for AAD should be exercised in patients presenting with acute sheering chest pain. While obtaining a proper history and performing a physical examination are important in the diagnostic process, not all cases present with typical symptoms. This can make diagnosis challenging, especially in patients who present with cognitive disorientation, making it difficult to take a proper history. We present the case of a 57-year-old male who presented to the emergency department (ED) of a community hospital with cognitive disorientation and abdominal pain that began two days prior to presentation and was associated with nausea, vomiting, and diarrhea. Laboratory results showed that the patient had an elevated white blood cell count, hyperkalemia, acute renal injury, and elevated lactate levels. Initial chest radiography and computed tomography showed no acute findings. Urine toxicology was positive for cocaine. The elevated lactate levels and cocaine use prompted us to order a computed tomography angiography (CTA) of the abdomen and pelvis with suspicion for bowel ischemia. He was found to have an abdominal aortic dissection with extrinsic compression of the patent true lumen. He was then transferred to a tertiary care facility, and a repeat CTA of the chest, abdomen, and pelvis showed a type A aortic dissection with extensive bowel ischemia. The patient was deemed too unstable for surgical repair and expired. The case highlights the challenges of diagnosing AAD due to its varied presentations and emphasizes the importance of maintaining a high suspicion for the condition in high-risk individuals. Additionally, the case highlights the potential complications associated with AAD.