What are the symptoms of abdominal pain related to a potential aortic aneurysm?

Symptoms of Abdominal Pain Related to Aortic Aneurysm

Abdominal pain related to aortic aneurysm typically presents as acute, deep, aching or throbbing pain that can spread to the back, buttocks, groin, or legs, and is often described as a "feeling of rupture." 1

Key Symptoms

Pain Characteristics

• Abrupt onset of severe pain is the most specific characteristic of aortic dissection or rupture 1
• Pain may be sharp, ripping, tearing, or knife-like 1
• Back pain is present in 65-90% of cases with intra-abdominal mycotic aneurysms 1
• Abdominal pain is experienced in approximately 25% of patients with aortic dissection 1
• Pain location varies based on aneurysm location:
  • Anterior chest pain is more common with Type A dissection (ascending aorta)
  • Back or abdominal pain is more frequent with Type B dissection (descending aorta) 1

Associated Symptoms

• Syncope occurs in approximately 15% of patients with Type A dissection and <5% with Type B dissection, indicating potential life-threatening complications 1
• Hypotension and shock may result from:
  • Aortic rupture
  • Acute severe aortic regurgitation
  • Cardiac tamponade
  • Extensive myocardial ischemia 1
• Pulsatile abdominal mass may be palpable, though the classic triad of pain, hypotension, and pulsatile mass is seen in only 25-50% of patients 2
• Feeling of fullness after minimal food intake in large abdominal aortic aneurysms 1

Presentation Variations

Symptomatic Presentations

• Contained rupture may present with atypical low flank or abdominal pain 1
• Chronic rupture can manifest as persistent lower back pain that may be misdiagnosed as lumbar ischialgia 3
• Fever is present in ≥70% of patients with infected (mycotic) aneurysms 1
• Neurological symptoms occur in 15-40% of cases and may include:
  • Acute paraplegia due to spinal ischemia
  • Stroke symptoms
  • Transient ischemic attack 1

Silent or Atypical Presentations

• AAAs are asymptomatic in two-thirds of cases until rupture occurs 1
• Clinical manifestation of mesenteric ischemia (when aneurysm affects intestinal blood supply) is frequently insidious with non-specific abdominal pain 1
• Patients may be painless in 40% of cases with mesenteric involvement 1
• Large aneurysms can sometimes reach significant size (even >10 cm) without causing symptoms 4

Warning Signs of Rupture

• Sudden, severe abdominal or back pain 2
• Hypotension and shock 1
• Shooting pain between shoulder blades 1
• Rapid expansion of a pulsatile abdominal mass 1
• Impending rupture can cause severe pain and hemodynamic instability 1

High-Risk Populations

• Men over 65 years with smoking history 5
• Patients with hypertension, peripheral artery disease, or coronary artery disease 5
• Family history of aortic diseases 1
• History of cardiac surgery 1
• Direct blunt chest trauma 1

Clinical Pitfalls

• Rupture into the retroperitoneal cavity can mimic other conditions like renal colic or musculoskeletal back pain 3
• Chronic aneurysm rupture may be misdiagnosed as lumbar ischialgia for months 3
• Mesenteric ischemia from aneurysm involvement has a high mortality rate (63% vs. 24% without this complication) 1
• Neurological symptoms may dominate the clinical picture, masking the underlying aortic condition 1

When a patient presents with abdominal pain that could indicate an aortic aneurysm, prompt imaging with computed tomography angiography is essential, as this condition represents a potential surgical emergency with high mortality if not diagnosed and treated quickly 1, 2.