Superior mesenteric arteriovenous fistula (SMAVF) is a rare postoperative vascular abnormality that can mimic more common causes of pulsatile abdominal masses. We report the case of a 49-year-old man with a history of laparotomy for volvulus 20 years earlier who presented with a pulsatile epigastric mass. Computed tomography angiography identified a 10 × 12 mm SMAVF, confirmed on angiography. Endovascular closure using a single Amplatzer vascular plug achieved complete occlusion without complications. This case underscores the importance of considering SMAVF in patients with atypical abdominal pulsations and highlights the effectiveness of a minimally invasive, single-device endovascular approach. © 2026 The Author(s)