Upper Gastrointestinal Bleeding from an Aberrant Left Subclavian Artery with Fatal Outcome
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Endoscopy in an 84-year-old male patient with hematemesis revealed arterial bleeding in the upper third of the esophagus. Angio-computed tomography showed a 5-cm-wide retroesophageal left subclavian artery (arrow 2) with no separation from the esophagus (arrow 3). Immediately thereafter, the patient died of massive hemorrhage from a fistula connecting the left subclavian artery aneurysm with the esophagus. It was too late for any endovascular or transesophageal attempt at closure with covered stents. The pathology literature contains a few cases of fistulas between an aberrant left subclavian artery and the esophagus caused by long-term gastric intubation. We were unable to find any accounts of spontaneous fistula formation, as occurred in our patient. The patient’s leukocytes and serum C-reactive protein were moderately elevated, pointing to a superinfection in the area of the fistula. Aberrant left subclavian artery is the most frequently occurring congenital anomaly of the aortic arch (1:200). Its origin from the aorta (arrow 1) is often bulbous (Kommerell diverticulum), and it is prone to aneurysmal degeneration (arrow 2). The most commonly occurring symptom is dysphagia.
Prof. Dr. med. Gerhard Rümenapf, Dr. med. Peter Bodrogi, Gefäßzentrum Oberrhein, email@example.com
Prof. Dr. med. Thomas Rabenstein, Innere Medizin und Gastroenterologie, Diakonissen-Stiftungs-Krankenhaus Speyer
Conflict of interest statement: The authors declare that no conflict of interest exists.
Translated from the original German by David Roseveare.
Cite this as: Rümenapf G, Bodrogi P, Rabenstein T: Upper gastrointestinal bleeding from an aberrant left subclavian artery with fatal outcome.
Dtsch Arztebl Int 2021; 118: 543. DOI: 10.3238/arztebl.m2021.0075