Background <p>Celiac trunk thrombosis is a rare vascular emergency that can lead to life-threatening complications including bowel ischemia and multi-organ dysfunction. The association between inflammatory autoimmune arthropathies and thrombotic events is well-established, but celiac trunk involvement remains exceptionally uncommon. This case highlights the diagnostic challenges and management considerations in patients with underlying inflammatory autoimmune conditions.</p> Case presentation <p>A 45-year-old male with ankylosing spondylitis under adalimumab presented with acute epigastric pain and bilious vomiting. Contrast-enhanced computed tomography with angiography revealed a 1.5 cm thrombus at the celiac trunk trifurcation with subtotal occlusion of the splenic and common hepatic arteries, high-grade stenosis of the left gastric artery, and subsequent splenic infarction. The patient was managed conservatively with anticoagulation and supportive care, with gradual clinical improvement.</p> Conclusions <p>This case demonstrates that celiac trunk thrombosis should be considered in patients with autoimmune arthropathies presenting with acute abdominal pain, even when initial clinical suspicion points toward more common diagnoses. Early recognition through appropriate imaging is crucial for optimal management and prevention of fatal complications.</p>