Unusual Cause of Upper Gastrointestinal Hemorrhage: Spontaneous Dissection of the Celiac Trunk

To the Editor: A 56-year-old man was admitted to our hospital with hematemesis and melena for 3 hours. He had also a history of upper abdominal pain after meal for 6 months and no any diseases. His vital signs were within normal limits. Physical findings were normal, but rectal examination revealed melena. Laboratory tests showed unremarkable findings and also hemostasis parameters were normal.

Endoscopy revealed pulsatile submucosal arterial vascular collaterals with nipple sign in stomach [Figure 1]. There was a small amount of fresh blood in stomach, but no active bleeding. He was treated conservatively and remained asymptomatic in follow-up. Abdominal-enhanced computed tomography (CT) showed dissection of the celiac trunk and enhancement perigastric and gastric intramural vascular collaterals due to chronic ischemia caused by celiac artery dissection [Figure 1].

Figure 1.

Endoscopic image of the pulsatile submucosal arterial vascular collaterals with nipple sign in the stomach (a), computed tomography (CT) angiographic image of dissection of the celiac trunk and perigastric and gastric intramural vascular collaterals (b and c).

Spontaneous dissection of the celiac trunk is uncommon and is rarely considered in the diagnosis of upper gastrointestinal (GI) hemorrhage. Its complications are ischemia to the supplied organs, aneurysm, and rupture.[1] To our knowledge, no cases of GI hemorrhage caused by celiac artery dissection are reported in the medical literature. Hence, we firstly report a case with upper GI hemorrhage caused by spontaneousdissectionof the celiac trunk.