Left subclavian artery-esophageal fistula induced by a paper star: a case report.

Chen-Sheng Lin,Cheng-Wen Lin

doi:10.7603/s40681-016-0018-0

Chen-Sheng Lin, Cheng-Wen Lin

Open Access

https://doi.org/10.7603/s40681-016-0018-0

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Journal: BioMedicine	Publication Date: Sep 1, 2016
Citations: 3	License type: cc-by

Affiliation: Kuang Tien General Hospital

Abstract

A subclavian artery-esophageal fistula usually occurs on the right side of an aberrant subclavian artery. It also rarely appears in the site between a non-aberrant subclavian artery and the esophagus due to the ingestion of a foreign body. Upper gastrointestinal bleeding in the case of a subclavian artery-esophageal fistula is rare but often fatal. Here, we report on a 62-year-old male patient with a left subclavian arteryesophageal fistula complicated by hemorrhagic shock. He swallowed a foreign body at a birthday party. An upper gastrointestinal endoscopy indicated a paper star lodged at 20 cm from the incisors, inducing a kissing esophageal ulcer around the esophageal sphincter. One month later, he suffered an unusually strong episode of hematemesis. Subsequently, a computed tomography angiography was performed and demonstrated a left subclavian artery-esophageal fistula. Finally, the fistula induced by the ingestion of a paper star was successfully treated by endovascular stent grafting.

Highlights

A subclavian artery-esophageal fistula is rarely reported, but it can appear in life-threatening conditions
A fistula between a non-aberrant subclavian artery and the esophagus is generally associated with the ingestion of a foreign body
It differs from an aberrant right subclavian artery fistula located posterior to the esophagus, which has a high susceptibility to extrinsic compression and pressure necrosis

Summary

Introduction

A subclavian artery-esophageal fistula is rarely reported, but it can appear in life-threatening conditions. The aberrant right subclavian artery is the major clinical feature in subclavian arteryesophageal fistula and is found in between 0.5% to 1.8% of the general population [1]. Long-term placement of nasogastric and endotracheal tubes become major risk factors to consider [2, 3]. A few cases of left subclavian artery-esophageal fistula have been reported, and these cases have generally been associated with the ingestion of a foreign body. Cases with upper gastrointestinal bleeding and a history of foreign body ingestion should be under considerable suspicion for the possibility of a left subclavian artery-esophageal fistula

Case report

Findings

Discussion