Aberrant Left Subclavian Artery-Esophageal Fistula in a Patient with a Prolonged Use of Nasogastric Tube: A Case Report and Literature Review

Abstract

Arterial-esophageal fistula is a rare but potentially fatal complication. Right aortic arch with aberrant left subclavian artery is a rare congenital vascular anomaly that can cause esophageal compression, particularly when the proximal portion of the aberrant subclavian artery forms a Kommerell’s diverticulum. Prolonged use of a nasogastric tube can cause pressure necrosis of the esophagus. We report a patient with massive gastrointestinal bleeding secondary to aberrant left subclavian artery-esophageal fistula after a prolonged use of nasogastric tube. A high index of suspicion is essential for better prognosis when a patient with congenital aortic arch anomaly shows upper gastrointestinal hemorrhage.

An extremely dangerous case of acute massive upper gastrointestinal bleeding: a case report

“…Based on medical history, physiological signs, examination and treatment, this case of delayed but high-risk massive upper GI bleeding was the result of a fish bone piercing the esophagus, causing the mediastinal abscess that corroded the LSA. Fistulas between the subclavian artery and esophagus are rare but can rapidly become life-threatening [ 12 , 13 ]. Clinically, among arterial-esophageal fistulas caused by esophageal foreign bodies, the proportion of LSA esophageal fistulas is only 2% [ 3 ].…”

An Aberrant Right Subclavian Artery–Esophageal Fistula—A Fatal Complication of a Common Anomaly: A Case Report and Review of Literature

“…2 Prolonged endotracheal and/or nasogastric intubation is the most common predisposing factor for fistula formation. On literature review, we found a total of 17 cases of aberrant subclavian artery–esophageal fistula in which the prolonged endotracheal and/or nasogastric intubation has been listed as a causative factor of fistula formation 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 ( Table 1 ). The average duration between NGT and endotracheal tube (ET) placement and first episode of bleeding is of 29 (6–56) and 23 (13–31) days, respectively.…”

“… 20 In few cases, initial “alarming” episodes of minimal bleeding have also been reported. 7 9 10 19 21 …”

“…20 In few cases, initial "alarming" episodes of minimal bleeding have also been reported. 7,9,10,19,21 ARSA can be visualized on CT angiography and can be confirmed on conventional angiography. Placement of esophageal Sengstaken-Blakemore tube can help in temporary control of bleeding.…”

Clinical Characteristics and Computed Tomography Findings in Adult Patients With an Aberrant Right Subclavian Artery: A Single-Center Retrospective Cohort Study

“…1,11,12 Formation of an arterio-esophageal fistula is a dreadful complication of a degenerated Kommerell diverticulum/aneurysm. Kim et al 13 found 40 cases of arterio-esophageal fistula-mainly caused by prolonged use of a nasogastric or endotracheal tube-in their literature review and reported a mortality rate of 60%. There are no surgical guidelines for the management of a Kommerell aneurysm.…”