總肝動脈動脈瘤是上消化道出血的罕見病因。在內視鏡的檢查中，總肝動脈動脈瘤可以因為對十二指腸的外源性壓迫而以黏膜下腫瘤來呈現。這類動脈瘤的出血通常是突然發生的而且再出血的風險很高。所以快速診斷與早期介入治療是必須的。我們報告一例中年男性患有以總肝動脈動脈瘤所形成的十二指腸黏膜下腫瘤而導致的上消化道出血。經過內視鏡血管夾止血，隨後的腹部電腦斷層掃描發現一個緊臨十二指腸球部的破裂之總肝動脈動脈瘤。在隔日患者併發復發性的上消化道出血和低血容性休克。之後病患接受外科修補術而且獲得良好的復原。在術後的六個月追蹤期間內病人不曾再有上消化道出血發生。我們歸納結論如下，血管動脈瘤性的病灶應該列入十二指腸黏膜下腫瘤的鑑別診斷。而血管夾對於疑似血管性的病灶是一項較好較安全的技術以達暫時性的止血。之後進一步診斷如電腦斷層檢查必須儘快獲得以便釐清黏膜下腫瘤的原因，並提供進一步治療的參考。對於血管瘤破裂所導致的消化道出血，外科或放射科介入才是根本的治療方式。

Hepatic artery aneurysm is an uncommon etiology of upper gastrointestinal bleeding. It can present as a duodenal submucosal tumor-like lesion due to extrinsic compression during endoscopic examination.Such aneurismal bleeding usually has abrupt onset and high risk of rebleeding. Hence, rapid diagnosis and early intervention is necessary. We presented a middle-aged man suffering from upper gastrointestinal bleeding due to a common hepatic artery aneurysm mimicking a duodenal submucosal tumor. After endoscopic hemostasis with hemoclip, the following computed tomography (CT) scan of abdomen showed a ruptured common hepatic artery aneurysm abutting the duodenal bulb. Recurrent gastrointestinal bleeding with hypovolemic shock complicated on the next day. This patient
subsequently underwent surgical repair of aneurysm of common hepatic artery and recovered smoothly. No more recurrent bleeding was noted during six months' follow-up. In summary, vascular aneurismal lesion should be included in the differential diagnosis of a duodenal submucosal tumor-like lesion. Then, hemoclipping is a better and safer technique for temporal hemostasis to a suspected vascular lesion. Finally, further work-up like CT must be obtained as soon as possible for clarifying the submucosal tumor-like lesion and guiding further management. Surgical or radiological intervention is definite for aneurismal rupture-related gastrointestinal hemorrhage.