Acute Abdominal Pain in Elderly, Should Abdominal Aortic Aneurysm be Considered? A Case Report and Literature Review

Introduction: Abdominal pain can also be caused by non-gastroitestinal origin, such as abdominal aortic aneurysm (AAA). Accompanying sign and symptoms, along with primary imaging modalities such as abdominal computed tomography and ultrasonography had a crucial role in determining the diagnosis.Result: 66-year old male presented with acute diffuse abdominal pain since 2 hours prior to arrival, along with flatulence, nausea, vomiting, and constipation since 2 days. Physical examination revealed hypotensive blood pressure and distended abdomen, hyperactive bowel sounds, with pain upon palpation on umbilical and lumbar area. Patient was anemia with marked leukocytosis. Working diagnosis of ileus obstruction was made, before a contrast-enhanced abdominal computed tomography (CT) scan showed signs of ruptured AAA. Immediate intervention with either Open Surgery Repair or Endovascular Aortic Repair were suggested, but however, the graft needed for surgery was unavailable, thus, a referral was considered as the best option.Discussion: It is important to diagnoses AAA before it ruptures, as only half of ruptured abdominal aortic aneurysm (rAAA) patients finally admitted to the hospital with another half reported die upon transportation. The presence of predisposing risk factors, hemodynamic instability and hemoperitoneum on abdominal CT accompanying the acute abdominal pain should raise the suspicion of AAA, although another symptoms resembling an acute abdomen and only two out of three classical triad of AAA presents. Surgical repair is the only curative way for rAAA, but unfortunately, the graft needed was unavailable in our hospital, thus a referral was chosen. Pre-referral management focusing on hemodynamic stability, additional imaging and laboratory test and hospital transfer protocol activation were done simultaneously.Conclusion: Abdominal pain in patients with predisposing risk factors, followed with hemodynamic instability and supporting imaging modalities can help to diagnose AAA. Pre-hospital and emergency department management is important while initiating patient referral to a higher level care facilities