Massive gastrointestinal hemorrhage due to aberrant right subclavian artery-esophageal fistula: Case report of a novel management technique - PowerPoint PPT Presentation

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Massive gastrointestinal hemorrhage due to aberrant right subclavian artery-esophageal fistula: Case report of a novel management technique

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Massive gastrointestinal hemorrhage due to aberrant right subclavian ... J. Brian Brizendine MD, James E. Morrison MD, Raymond P. Bynoe MD, Dorn Smith MD, ... – PowerPoint PPT presentation

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Title: Massive gastrointestinal hemorrhage due to aberrant right subclavian artery-esophageal fistula: Case report of a novel management technique


1
Massive gastrointestinal hemorrhage due to
aberrant right subclavian artery-esophageal
fistula Case report of a novel management
technique
J. Brian Brizendine MD, James E. Morrison MD,
Raymond P. Bynoe MD, Dorn Smith MD, Stephen A.
Fann MD University of South Carolina School of
Medicine, Palmetto Health Richland
Hospital Columbia, South Carolina 29203
Introduction Arterioesophageal fistula is a rare,
typically fatal condition which was first
described by Dubreuil in 1818 and typically
involves the thoracic aorta. An even more
devastating variant is a fistula between the
esophagus and an aberrant right subclavian artery
(ARSA). While the anomalous arterial anatomy is
present in up to 1.8 of the population, there
have only been 12 published case reports
describing this unusual and nearly always fatal
complication. The only 2 reported survivors
required resuscitative left thoracotomy.
Discussion Finally, a series of 4 Foley catheters
were tied together and the balloons sequentially
inflated within the esophagus. This effectively
tamponaded the bleeding and allowed partial
closure of the gastrotomy and temporary abdominal
closure with a wound VAC device The patient was
then evaluated by arteriography which identified
the source of bleeding as an ARSA-esophageal
fistula. She subsequently underwent a median
sternotomy for ligation of the fistula and
esophageal repair.
Conclusion The majority patients with this rare
complication do not survive due to the massive
volume of blood loss from an anatomically
difficult location. This case represents a novel
approach to emergently control the bleeding and
restore hemodynamic stability in a setting where
other therapeutic modalities are not available or
are ineffective. Furthermore, this technique
obviated the need for a resuscitative thoracotomy

Case presentation A 51-year-old woman initially
presented for repair of a colovesical fistula.
Postoperatively, she developed an upper GI
hemorrhage which was explored and found to be
from a bleeding gastric ulcer which was oversewn.
Twelve hours later, she again developed massive
hematemsis and was emergently returned to the
operating room. This time the hemorrhage
emanated from an unknown location within the
thoracic esophagus. An esophageal origin for
the hemorrhage was confirmed after excluding the
previously ligated gastric ulcer site.
Esophagoscopy was attempted however the volume
of blood precluded effective visualization. A
Sengstaken-Blakemore tube was attempted however,
this too was not effective at controlling the
hemorrhage.
References Blah blah
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