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Year : 2017  |  Volume : 2  |  Issue : 1  |  Page : 21-25

Missed diagnosis of acute stanford Type A aortic dissection presenting with abdominal pain in the setting of acute appendicitis

1 Department of Surgery, Wellstar Atlanta Medical Center, Atlanta, GA, USA
2 Wellstar Atlanta Medical Center, Atlanta, GA, USA

Correspondence Address:
Jonathan Nwiloh
Department of Surgery, Wellstar Atlanta Medical Center, Atlanta, GA 30312
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/njct.njct_3_17

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Acute Stanford Type A aortic dissection (ATAAD) has a high mortality rate, particularly with delayed diagnosis and treatment. A 30-year-old male Marfan patient presented to the emergency department with acute abdominal pain and underwent laparoscopic appendectomy for acute appendicitis about 15 h later. Postoperatively, the patient developed acute pulmonary edema and respiratory failure. Transthoracic echocardiogram revealed severe aortic insufficiency, 7.5 cm root aneurysm, severe left ventricular dysfunction, and probable ATAAD. Following computed tomography angiogram confirmation of ATAAD, he underwent emergency root and ascending aortic replacement with a composite mechanical valve graft 48 h after hospitalization. The patient had Escherichia coli pericarditis at time of sternotomy likely hematogenous from appendicitis and later also developed postoperative pneumonia. At 2 years follow-up, he was doing well without any evidence of prosthetic valve conduit infection. The simultaneous presentation of two unrelated pathologies with acute abdominal pain led to the initial missed diagnosis of ATAAD, which delayed treatment and increased risks for morbidity and mortality. Therefore, Marfan syndrome patients presenting with acute abdomen should be ruled out for acute aortic dissection despite any other obvious concomitant pathology, especially in younger patients.

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