Aberrant right subclavian artery-esophageal fistula: A cause of overwhelming upper gastrointestinal hemorrhage

Abstract

A patient had massive hematemesis due to a fistula between an unsuspected aberrant right subclavian artery and the esophagus, with the fistula caused by prolonged esophageal intubation. Lack of awareness of this complication delayed the correct diagnosis, which was eventually made at a second angiographic study. With knowledge of the fistula, this potentially fatal situation can be promptly diagnosed by endoscopy and emergency angiography. Transcatheter embolization is suggested as a potential alternative to surgery in the treatment of the aberrant right subclavian artery--esophageal fistula.

Aberrant Right Subclavian Artery-Esophageal Fistula in 20-Year-Old with VATER Association

“…3,7,10,18,22 Furthermore, massive hematemesis following withdrawal of nasogastric tube or deflation of the esophageal balloon during an endoscopic procedure has also been reported. 9,18 In a stable patient, esophagogastroduodenoscopy and CT with intravenous contrast are seemingly the diagnostic procedures of choice, with contrast material in the stomach on CT scan being highly suggestive of the presence of a fistula when this condition is considered. Diagnosis can be further confirmed by angiography.…”

Fístula de artéria subclávia direita anômala com esôfago – hemorragia digestiva alta maciça secundária a intubação gástrica prolongada

“…Existem poucos casos relatados após intubação esofá-gica prolongada. 3,7 A proximidade anatômica dessa artéria anômala com o esôfago e eventualmente com a traqueia torna-a vulnerável à compressão extrínseca, quer por sondas gástricas, tubos traqueais ou condutos vasculares. 5 A incidência relativamente elevada dessa anomalia e o uso comum de sondas gástricas em ambiente hospitalar tornam mais frequente a possibilidade de ocorrência dessa complicação.…”

“…3 Um elevado índice de suspeição é essencial para o diagnóstico precoce dessa situação. 7 O relato do presente caso tem como objetivo sensibilizar os anestesiologistas para a presença dessa anomalia congênita, raramente identificada, mas potencialmente responsável por complicações graves e/ou fatais, associadas a atos tão simples como colocação de sondas gástricas ou tubos traqueais.…”

Retroesophageal subclavian artery—Esophageal fistula: A rare complication of a salivary bypass tube

“…This leads to thrombosis of the vasa vasorum and ischemia of the digestive wall, and with time this mechanism is probably enhanced by local infectious processes, esophageal mucosal damage, and cancer. [14][15][16] Specifically, in patients with cancer, chemoradiation has been associated with tissue ischemia, especially in the face of healing or contaminated wounds. This phenomenon is well recognized as a cause of fistulas, most prominently represented by postlaryngectomy patients.…”