• Suqiao Zhang, Rui Lian, and Guoqiang Zhang.
• Department of Emergency Medicine, China-Japan Friendship Hospital, Beijing, China.
• Medicine (Baltimore). 2018 Jun 1; 97 (24): e11126.

RatinalePenetrating aortic ulcer (PAU) and rupture of a superior mesenteric artery branch is a rare but potentially life-threatening condition.Patient ConcernsWe describe a case of 73-year-old man was brought to our Emergency Department for intermittent back pain.DiagnosesThe final diagnoses are PAU (Stanford B) and rupture of a branch of the superior mesenteric artery.InterventionsTwo covered stents were placed in the thoracic aorta and the right external iliac artery, and the superior mesenteric artery branch was embolized. The patient subsequently underwent exploratory laparotomy, where 6000 to 7000mL of intra-abdominal hematoma was evacuated.OutcomesAfter the operation, the patient recovered smoothly and was discharged 20 days later. During 3-year follow-up, the patient did not develop any pain or discomfort.LessonsAcute aortic syndrome (AAS) and acute coronary syndrome (ACS) may be difficult to distinguish, particularly for elderly patients with extensive atherosclerotic disease. Antithrombotic agent administration should be carefully considered.

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