A Rare Cause of Upper Gastrointestinal Bleeding: Superior Mesenteric Artery Aneurysm

Superior mesenteric artery (SMA) aneurysms are a rare cause of gastrointestinal (GI) bleeding that is usually underdiagnosed. These conditions can lead to severe complications, making prompt treatment essential. We report a case of a 87-year-old female patient admitted for intense pain in the abdominal area. After a 24-hour hospital stay, she had an episode of hematochezia, hematemesis, and intense epigastric pain. Upper GI endoscopy revealed a foreign body in the duodenum, which was removed. The bleeding and the hemodynamic instability were persistent even after the removal of the foreign body. A CT angiography revealed an aneurysm in the SMA with active contrast extravasation. The patient underwent endovascular treatment with coil embolization, achieving complete hemodynamic stabilization without complications. GI bleeding from an aneurysm in the SMA is an unusual but critical entity with high mortality (40-60%); thus, rupture of the SMA aneurysm should always be considered in the differential diagnosis in cases with persistent GI bleeding. Regarding the hemodynamic stability of the patient or the patient's overall clinical condition, the available treatment options include endoscopic interventions or open surgery. Endovascular treatment offers a safe and effective alternative to open surgery, with favorable outcomes. Prompt diagnosis and, most of the time, endovascular embolization are crucial for successful management of SMA aneurysm-related upper GI bleeding.