The so-called Muswell Hill Murderer Dennis Nilsen spent his final day in prison in “excruciating pain” lying in his cell suffering from internal bleeding, an inquest has heard.
The 72-year-old convicted serial killer died at HMP Full Sutton in east Yorkshire last May.
He had served 34 years of a life sentence for the notorious series of killings in the late 1970s and early 1980s.
Nilsen is believed to have killed as many as 15 men at his north London home. His targets were predominantly homeless and gay.
His inquest at Hull Coroner's Court heard how the killer had isolated himself from other inmates and staff but was otherwise a good prisoner, despite regularly refusing to engage with healthcare services.
Coroner Professor Paul Marks heard how he spent his final hours in prison in "excruciating pain" and lying in his own filth as he suffered a ruptured abdominal aortic aneurysm.
The inquiry heard how the killer presented in a "pale" and "ashen" state prior to his eventual death.
Hull coroner Professor Paul Marks said of the prisoner: "Although he would not often talk to staff and he did not appear to have any close inmates or associates, he got on well and appeared to be a good prisoner."
Recording his verdict, he simply said: "Dennis Andrew Nilsen died of natural causes."
During his killing spree, Nilsen would befriend his subjects in pubs and bars in London before luring them into his flat, where he would kill them and sit with their corpses before dismembering them.
His crimes were discovered when a drain outside his home on Cranley Gardens, Muswell Hill, became blocked by human remains that he had tried to flush away.
Nilsen was jailed for life with a recommendation he serve a minimum of 25 years in 1983, on six counts of murder and two of attempted murder. The sentence was later upgraded to a whole-life tariff.
The killer's inquest heard how he was found hunched over in pain in his cell on the morning of May 10 last year but, after healthcare assistants found his pulse and blood pressure were within normal range, he voluntarily returned to his cell.
At around 5pm that day, an ambulance was called to HMP Full Sutton, East Yorkshire, after it was found that his condition had deteriorated. A Prison and Probation Ombudsman report found there was an "unacceptable delay" of around 40 minutes in calling the ambulance to the prison.
Paramedics found that the prisoner had a "pulsing abdominal mass", which was later found to be the ruptured abdominal aortic aneurysm and a high aspiration rate of 40, where normally one of between 16 and 20 would be expected.
The notorious murderer was taken to hospital in York where he had emergency surgery but, despite the procedure being successful, he died two days later, due to blood loss and the stress of surgery.
The medical cause of death was given as a pulmonary embolism and retroperitoneal haemorrhage, linked to the ruptured aneurysm.
The report from the Prisons and Probation Ombudsman also stated that Nilsen had been left to "lay in his own faeces, deteriorating for two-and-a-half hours" after rejecting the opportunity to be seen for longer in the healthcare wing.
But it also stated that the treatment he initially received in prison was "commensurate with that which he would have received in the community".
Lisa Noble, the head of healthcare at Full Sutton, said Nilsen had been reluctant to engage previously with healthcare assistants in the prison.
"He did not particularly like healthcare, and he did not particularly like healthcare staff", she told the day-long hearing.
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