右锁骨下动脉异常-食管瘘患者尸检诊断为大量胃肠道出血。
Postmortem diagnosis of massive gastrointestinal bleeding in a patient with aberrant right subclavian artery-esophageal fistula.
作者信息
Watanabe Maiko, Suzuki Kei, Fujinaga Kazuhisa, Yamamoto Akitaka, Fujioka Masaki, Katayama Naoyuki, Imai Hiroshi
机构信息
The Emergency and Critical Care Center Mie University Hospital Tsu Mie Japan.
Department of Hematology and Oncology Mie University Graduate School of Medicine Tsu Mie Japan.
出版信息
Acute Med Surg. 2015 Jul 14;3(2):139-142. doi: 10.1002/ams2.136. eCollection 2016 Apr.
CASE
Aberrant right subclavian artery-esophageal fistula is a rare, but fatal, complication. A 55-year-old febrile man with a nasogastric feeding tube developed sudden massive hematemesis and shock.
OUTCOME
Upper endoscopy revealed an intragastric hematoma with no active bleeding observed except for oozing from an esophageal tear. Enhanced computed tomography scan detected aberrant right subclavian artery but was unable to determine the bleeding source. Repeat endoscopy carried out on day 2 confirmed hemostasis and the disappearance of the intragastric hematoma. However, the patient suddenly developed recurrent massive hematemesis with refractory shock on day 4 and died. Postmortem computed tomography revealed endoscopic clips in contiguity with aberrant right subclavian artery; a final diagnosis of aberrant right subclavian artery-esophageal fistula was made.
CONCLUSION
Our case demonstrates aberrant right subclavian artery-esophageal fistula may present with transient spontaneous hematemesis in a state of shock, possibly related to fever of unknown origin, and is challenging to diagnose by repeated endoscopy once hematemesis develops.
病例
迷走右锁骨下动脉-食管瘘是一种罕见但致命的并发症。一名55岁发热男性，留置鼻胃饲管，突发大量呕血和休克。
转归
上消化道内镜检查发现胃内血肿，除食管撕裂处渗血外未观察到活动性出血。增强计算机断层扫描检测到迷走右锁骨下动脉，但无法确定出血来源。第2天重复内镜检查证实止血且胃内血肿消失。然而，患者在第4天突然再次出现大量呕血并伴有难治性休克，最终死亡。尸检计算机断层扫描显示内镜夹与迷走右锁骨下动脉相邻；最终诊断为迷走右锁骨下动脉-食管瘘。
结论
我们的病例表明，迷走右锁骨下动脉-食管瘘可能在休克状态下出现短暂性自发性呕血，可能与不明原因发热有关，一旦发生呕血通过重复内镜检查诊断具有挑战性。
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