Maen Aboul Hosn, Bassem Safadi, Ali Hallal, Division of General Surgery, Department of Surgery, American University of Beirut, Riad El-Solh, Beirut 1107 2020, Lebanon.
World J Gastrointest Surg. 2014 Jun 27;6(6):117-21. doi: 10.4240/wjgs.v6.i6.117.
A fistula formation between the esophagus and an aberrant right subclavian artery is a rare but fatal complication that has been mostly described in the setting of prolonged nasogastric intubation and foreign body erosion. We report a case of a young morbidly obese patient who underwent sleeve gastrectomy that was complicated by a postoperative leak at the level of the gastroesophageal junction. A covered esophageal stent was placed endoscopically to treat the leak. The patient developed massive upper gastrointestinal bleeding secondary to the erosion of the stent into an aberrant retroesophageal right subclavian artery twelve days after stent placement. She was ultimately treated by endovascular stenting of the aberrant right subclavian artery followed by thoracotomy and esophageal repair over a T-tube. This case report highlights the multidisciplinary approach needed to diagnose and manage such a devastating complication. It also emphasizes the need for imaging studies prior to stent deployment to delineate the vascular anatomy and rule out the possibility of such an anomaly in view of the growing popularity of esophageal stents, especially in the setting of a leak.
食管和异常右锁骨下动脉之间形成瘘管是一种罕见但致命的并发症，主要发生在长期鼻胃管插入和异物侵蚀的情况下。我们报告了一例年轻病态肥胖患者，在接受袖状胃切除术后，胃食管交界处发生术后漏。采用内镜下放置覆盖食管支架来治疗漏。十二天后，支架侵蚀异常食管后右锁骨下动脉，患者发生大量上消化道出血。最终通过对异常右锁骨下动脉进行血管内支架置入术，然后进行开胸手术和 T 型管下食管修复来治疗。本病例报告强调了诊断和处理这种破坏性并发症所需的多学科方法。鉴于食管支架越来越受欢迎，尤其是在漏的情况下，该报告还强调了在支架放置前进行影像学检查的必要性，以明确血管解剖结构并排除这种异常的可能性。
