Emergency Department Diagnosis and Initial Management of an Unruptured Celiac Artery Aneurysm: A Case Report

Abstract Background Celiac artery aneurysm (CAA) is an uncommon visceral artery aneurysm that may present with nonspecific abdominal symptoms but can cause life-threatening hemorrhage after rupture. This report describes a practical emergency diagnostic pathway and guideline-informed individualized management of an intact aneurysm near the boundary between intervention and observation. Case presentation: An 86-year-old man with hypertension, stage 3 chronic kidney disease, and prior ischemic stroke presented with sudden epigastric pain radiating to the back. Initial clinical, laboratory, electrocardiographic, and point-of-care ultrasonographic evaluation did not reveal another clear explanation for the pain, although a focal vascular abnormality was suspected in the celiac artery region. Because the finding could not be adequately characterized owing to the deep location and limited acoustic window, computed tomography angiography was performed and identified an intact approximately 2.0-cm celiac trunk aneurysm without active extravasation, peri-aneurysmal hematoma, or dissection. Intravenous labetalol was titrated during emergency stabilization toward a systolic blood pressure of approximately 100–120 mmHg. After intensive monitoring and multidisciplinary assessment, conservative management was selected because the patient remained stable and had advanced age, a debilitated baseline, chronic kidney disease, prior stroke, and substantial anticipated procedural risk. His pain resolved, and he was discharged in stable condition on hospital day 10. Conclusions This case demonstrates how rapid bedside assessment, timely escalation to definitive vascular imaging, exclusion of immediately life-threatening complications, and hemodynamic stabilization can support safe transition from emergency care. For an intact CAA near a guideline-based treatment threshold, management should integrate aneurysm size and symptoms with physiological stability, comorbidity, life expectancy, and procedural risk rather than apply a size criterion in isolation.