Constipation as an Indicator of Abdominal Aortic Aneurysm Rupture in a High-Risk Smoker: A Case Report

Abdominal aortic aneurysms are potentially fatal expansions of the abdominal aorta that are at higher risk of occurring in patients who smoke. The presentation classically involves a triad of hypotension, abdominal pain, and pulsatile abdominal mass. We present a case herein of a ruptured infrarenal abdominal aortic aneurysm that was nearly missed due to its atypical presentation at a primary care clinic and the patient's fragmented medical care. Presenting with severe abdominal pain, constipation, nausea, and anorexia, these symptoms initially obscured the emergent nature of this condition. The patient was also recently discharged from hospitalization for musculoskeletal chest pain that further clouded the presence of an abdominal aortic aneurysm, and the patient's background of a 58.5 pack-year smoking history and infrequent medical follow-up complicated the picture. Emergent endovascular aneurysm repair stabilized the patient, allowing for discharge just three days later. This incident illustrates the dangers of atypical presentations and fragmented care, demanding both hypervigilance and proactive screening integration, especially when preventative measures have been neglected.