When ulcer isn’t ulcer: A case report of a fatal case report of Stanford Type A aortic dissection presenting as epigastric pain

Aortic dissection is a life-threatening vascular emergency that often presents with non-specific symptoms, making timely diagnosis challenging. It may mimic conditions such as peptic ulcer disease, pancreatitis, or myocardial infarction. Risk factors include systemic hypertension, atherosclerosis, connective tissue disorders (e.g., Marfan syndrome and Ehlers-Danlos syndrome), and, less commonly, syphilis. While many aortic aneurysms remain asymptomatic, rupture, closely associated with aneurysm size, carries a high risk of mortality. We present the case of a 47-year-old male with long-standing, poorly controlled hypertension, who arrived at the emergency department with severe epigastric pain, dizziness, and a brief loss of consciousness. He was initially misdiagnosed with peptic ulcer disease; however, imaging through echocardiography and computed tomography angiography confirmed a DeBakey Type I (Stanford Type A) aortic dissection. This case emphasizes the need for a high index of suspicion for aortic dissection in atypical abdominal presentations and the critical role of early imaging in improving clinical outcomes.