Spontaneous isolated celiac artery dissection mimicking gastrointestinal stromal tumor and causing upper gastrointestinal hemorrhage: a case report

BACKGROUND: Spontaneous isolated celiac artery dissection leading to hepatic artery pseudoaneurysm, which subsequently erodes into the adjacent bowel and forms a hepatic artery-duodenal fistula, represents an exceedingly rare cause of upper gastrointestinal hemorrhage. CASE PRESENTATION: A 56-year-old man was admitted with a 2-h history of dizziness and melanena for 30 min. During hospitalization, he developed right shoulder and back pain. Acute coronary syndrome was initially suspected, but it was ruled out via coronary angiography. The patient again developed melena with hematemesis, and the hemoglobin level decreased from 128 to 69 g/L. Emergency gastroenteroscopy indicated a gastrointestinal stromal tumor with active bleeding. Prior to scheduled surgical intervention, contrast-enhanced abdominal computed tomography confirmed hepatic artery pseudoaneurysm diagnosis. The patient subsequently underwent endovascular intervention, including stent placement in the celiac trunk and hepatic artery pseudoaneurysm embolization. Gastroscopy and computed tomographic angiography at 3 months postoperatively demonstrated satisfactory recovery. At the 10-month follow-up, the patient remained free of recurrent bleeding episodes or other procedure-related complications. CONCLUSION: Increased awareness of spontaneous isolated celiac artery dissection and recognition of the endoscopic features of hepatic artery-duodenal fistula is crucial. Timely endovascular intervention is vital for high-risk spontaneous isolated celiac artery dissection.