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

Sep 30, 2026

Uploaded by McGucket

Abdominal aortic aneurysms are dangerous dilations of the abdominal aorta, with a higher likelihood among people who smoke. A ruptured infrarenal AAA case is presented in which emergent disease was nearly overlooked in primary care due to an atypical symptom pattern and fragmented prior medical follow-up. Severe abdominal pain, constipation, nausea, and anorexia initially obscured the critical nature of rupture. Recent hospitalization for musculoskeletal chest pain and a 58.5 pack-year smoking history further complicated recognition. Emergent endovascular repair stabilized the patient and enabled discharge three days later, underscoring the need for vigilance and proactive screening.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages4

Reading Time10 min

AccessFree to download

Abstract

Introduction

Case Presentation

Primary care follow-up

Emergency department evaluation

Review began 11/02/2025 Review ended 11/26/2025 Published 12/09/2025 © Copyright 2025 Lababidi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CCBY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited. DOI: 10.7759/cureus.98787 Open Access Case Report Constipation as an Indicator of Abdominal Aortic Aneurysm Rupture in a High-Risk Smoker: A Case Report Hamdi Lababidi 1, Ghazwan I. Bahro 1 , Adil S. Mohammed 1, Ihsan Al-Sabbagh 1 1. Department of Internal Medicine, Central Michigan University College of Medicine, Saginaw, USA Corresponding author: Ihsan Al-Sabbagh, [alsab1i@cmich.edu](alsab1i@cmich.edu) Abstract Abdominal aortic aneurysms are potentially fatal expansions ofthe 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 followup 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. Categories: Internal Medicine, Preventive Medicine, Cardiac/Thoracic/Vascular Surgery Keywords: abdominal aortic aneurysm, case report, constipation, emergent endovascular aneurysm repair, primary care Introduction Abdominal aortic aneurysm (AAA) is a focal expansion of the abdominal aorta and is diagnosed by a maximum aortic diameter of ≥30 mm on imaging [1] . It is typically asymptomatic until rupture, which is fatal without surgical intervention. Risk factors for AAA diagnosis include male sex, hypertension, smoking, and coronary artery disease. The United States Preventive Services Task Force issued a 'B ' recommendation for a 1-time screening for AAA with ultrasonography in men aged 65 to 75 years who have “ever smoked”(defined as ≥100 cigarettes in a lifetime) [2], given that smoking is the strongest predictor of AAA prevalence, growth, and rupture rates. The AAA rupture typically presents with a sudden onset of severe abdominal pain, severe hypotension, lower extremity weakness, loss of pulses in the bilateral lower extremities, and a pulsatile abdominal mass. A Grey Turner sign or Cullen sign may manifest as well [3] . However, some cases may only manifest a portion of these signs and symptoms or include atypical presentations. We report a case of AAA rupture in a patient with abdominal pain and constipation. The purpose of this case is to deliberate an atypical presentation of AAA rupture as well as to highlight the importance of preventive screening in patients at higher risk of AAA rupture. Case Presentation A 69-year-old male with a significant history of heavy smoking presented for primary care follow-up after hospitalization within the past week. He had been admitted for a sudden, sharp left chest pain reproducible to palpation. Investigations during his admission showed no acute ischemic changes on the electrocardiogram. His initial troponin was 13.8 ng/L, trending down to 9.6 ng/L. Laboratory findings included leukocytosis (white blood cell cou

FAQs

What symptoms in the case masked the severity of abdominal aortic aneurysm rupture?

The patient presented with severe abdominal pain plus constipation, nausea, and anorexia. These symptoms initially obscured the emergent nature of a ruptured abdominal aortic aneurysm.

Why was the rupture nearly missed before emergency treatment?

The report highlights an atypical presentation at a primary care clinic and fragmented medical care. A recent discharge for musculoskeletal chest pain also clouded recognition.

What treatment was used and what was the outcome?

The patient received emergent endovascular aneurysm repair, which stabilized him. Discharge occurred three days later.

Sep 30, 2026

Uploaded by McGucket