Aortoesophageal fistula in a 13-yr-old girl: complication after nasogastric tube placement in the setting of right-sided aortic arch.

OBJECTIVE

To report a case of aortoesophageal fistula in a 13-yr-old girl with a right aortic arch that occurred after nasogastric intubation after surgery for lumbar kyphosis.

DESIGN

Case report.

SETTING

Tertiary care pediatric intensive care unit.

PATIENTS

One 13-yr-old girl who underwent operative repair of a 45-degree kyphosis at the level of the second to fourth lumbar vertebrae.

MAIN RESULTS

On the eighth postoperative day after operative kyphosis repair and intraoperative placement of a nasogastric tube, sudden massive hematemesis developed and the patient died. Autopsy revealed esophageal ulceration with erosions. One of these had a fistulous tract connecting to the descending aorta. The aortoesophageal fistula was observed where the descending aorta indented the posterior wall of the esophagus, as the aorta crossed the midline from the right side to the left side of the body.

CONCLUSION

In the setting of right-sided aortic arch and other abnormalities of the aortic arch, nasogastric intubation may result in aortoesophageal fistula, massive hemorrhage, and death. Right-sided aortic arch should be added to the list of conditions for which utmost caution during nasogastric intubation is warranted.