Massive upper gastrointestinal bleeding secondary to an esophago-arterial fistula (arteria lusoria)

Rev Esp Enferm Dig. 2021 Sep;113(9):687. doi: 10.17235/reed.2021.7811/2021.

Abstract

A 50-year-old patient with a history of hypopharyngeal cancer, laryngectomy, adjuvant chemoradiotherapy and incompetent tracheoesophageal fistula was admitted for elective pharingostomal surgery. During the surgery, he presented esophageal bleeding with hemodynamic instability. After stabilization, a gastroscopy was performed through the stoma, showing arterial bleeding 4-5 cm distal to the stoma, which was controlled with three hemostatic clips. After four hours, the patient presented a new episode of bleeding with hemodynamic instability and a Sengstaken-Blakemore tube was placed that stopped the bleeding. Computed tomography angiography (CT angiography) was performed, which showed an aberrant right subclavian artery with a retroesophageal pathway, in close contact with the area where the clips were placed. An endovascular stent was placed in the right subclavian artery with control of the bleeding after removal of the Sengstaken-Blakemore tube. The patient was discharged seven days later.

Publication types

  • Case Reports

MeSH terms

  • Cardiovascular Abnormalities*
  • Fistula*
  • Gastrointestinal Hemorrhage / diagnostic imaging
  • Gastrointestinal Hemorrhage / etiology
  • Gastrointestinal Hemorrhage / therapy
  • Humans
  • Male
  • Middle Aged
  • Subclavian Artery / abnormalities
  • Subclavian Artery / diagnostic imaging
  • Subclavian Artery / surgery

Supplementary concepts

  • Aberrant subclavian artery