Successful management of massive bleeding due to aberrant right subclavian artery-esophageal fistula in a child with head injury

Abstract

Abstract Aberrant right subclavian artery (ARSA)-esophageal fistula has rarely been reported but has fatal outcomes in most cases. We report a 10-year-old girl who presented with massive hematemesis during recovery from a head injury caused by a motor vehicle accident. Prompt detection of the esophageal bleeding point by esophagoscopy followed by a balloon tamponade led to temporary hemostasis, during which time an emergency operation was prepared and started promptly. Two-staged surgery was performed with a successful outcome; direct vascular access to the right atrium and suturing of the bleeding point of ARSA through a T-shaped skin incision with median sternotomy were performed in the first surgery, and dividing the ARSA and repairing the esophagus were performed in the second surgery on the following day. Multidisciplinary treatment with pediatric intensivists, gastroenterologists, cardiovascular surgeons, and general surgeons is essential to address the near-fatal complication of ARSA in children.