Abstract
Arterio-esophageal fistula (AEF), whether congenital or acquired, is a rare condition which can lead to fatal upper gastrointestinal bleeding. We report here a young man who developed a subclavian-esophageal fistula (SEF) secondary to chicken bone impaction in the upper esophagus. The diagnosis was reached by urgent upper endoscopy and Computed Tomography of the chest which showed pseudo-aneurysmal changes at left subclavian artery with leaked contrast through the fistula towered the esophagus. Urgent endo-vascular angiography confirmed the subclavian arterio-esophageal fistula that was managed uneventfully using covered 6mm Viban stent-graft. The patient survived this serious condition and was discharged home in good condition.
Highlights
Bleeding from an arterio-esophageal fistula (AEF) is a rare and mostly fatal condition
We report here a young man who developed a subclavian-esophageal fistula (SEF) secondary to chicken bone impaction in the upper esophagus
This arises from an aberrant subclavian artery in most of occasions, it can result as a complications of foreign body impaction in the upper esophagus leading to an esophageal-aortic or esophageal-subclavian fistula in a normal anatomy setting [2] [3] [4]
Summary
Bleeding from an arterio-esophageal fistula (AEF) is a rare and mostly fatal condition. The first case of aorto-esophageal Fistula was described by the French naval surgeon Dubreuil in 1818 [1] This arises from an aberrant subclavian artery in most of occasions, it can result as a complications of foreign body impaction in the upper esophagus leading to an esophageal-aortic or esophageal-subclavian fistula in a normal anatomy setting [2] [3] [4]. This condition should be suspected if a patient reported difficulty in swallowing, massive vomiting of blood, or underwent recent aortic or esophageal surgery [1]. This serious complication was discovered early and well managed by endovascular stent grafting [6] [7]
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