Catastrophic STS/SVS type B3 aortic dissection complicated by hepatic portal venous gas and multi-organ malperfusion: a case report

The case involves a 64-year-old male with hypertension who presented to the emergency department with severe abdominal pain lasting 8 hours. Physical examination revealed significant blood pressure asymmetry between limbs with a difference of up to 100 mmHg. Computed tomography angiography confirmed a Type B3 aortic dissection extending from the aortic arch to the iliac arteries, affecting the celiac trunk and superior mesenteric artery. Critical findings included hepatic portal venous gas, pneumatosis intestinalis, and multi-organ ischemia. Laboratory results showed elevated white blood cell count (27.1 × 10⁹/L) and massive cytokine storm (IL-6: 14,001.98 pg/mL) with refractory lactic acidosis. Given the grave prognosis, the family chose palliative care and the patient died 47 hours after this decision.