Open AccessPostmortem diagnosis of massive gastrointestinal bleeding in a patient with aberrant right subclavian artery–esophageal fistula
Author(s) -
Watanabe Maiko,
Suzuki Kei,
Fujinaga Kazuhisa,
Yamamoto Akitaka,
Fujioka Masaki,
Katayama Naoyuki,
Imai Hiroshi
Publication year - 2016
Publication title -
acute medicine and surgery
Language(s) - English
Resource type - Journals
ISSN - 2052-8817
DOI - 10.1002/ams2.136
Subject(s) - medicine , surgery , fistula , hematoma , radiology , subclavian artery , endoscopy , shock (circulatory) , hemostasis
Case Aberrant right subclavian artery–esophageal fistula is a rare, but fatal, complication. A 55‐year‐old febrile man with a nasogastric feeding tube developed sudden massive hematemesis and shock. Outcome Upper endoscopy revealed an intragastric hematoma with no active bleeding observed except for oozing from an esophageal tear. Enhanced computed tomography scan detected aberrant right subclavian artery but was unable to determine the bleeding source. Repeat endoscopy carried out on day 2 confirmed hemostasis and the disappearance of the intragastric hematoma. However, the patient suddenly developed recurrent massive hematemesis with refractory shock on day 4 and died. Postmortem computed tomography revealed endoscopic clips in contiguity with aberrant right subclavian artery; a final diagnosis of aberrant right subclavian artery–esophageal fistula was made. Conclusion Our case demonstrates aberrant right subclavian artery–esophageal fistula may present with transient spontaneous hematemesis in a state of shock, possibly related to fever of unknown origin, and is challenging to diagnose by repeated endoscopy once hematemesis develops.