Zheng Shiqin, Wang Xiaosong, Chen Shuang, Wei Jianming, Wei Zhiqing, Miao Lin, Zhang Xiuhua
Institute of Digestive Endoscopy and Medical Center for Digestive Diseases.
Departments of Radiology.
Surg Laparosc Endosc Percutan Tech. 2019 Oct;29(5):e69-e71. doi: 10.1097/SLE.0000000000000696.
A 67-year-old man who received endoscopic submucosal dissection for an early squamous esophageal cancer was hospitalized for dysphagia. The mucosal defect was over three quarters of the circumference, and the distal edge of the resection scar formed the stenosis after 8 months. After experiencing conservative treatment, probe expansion, and esophageal stent placement, the symptom of deglutition disorder in the patient was improved, but persistent hemorrhage and progressive anemia occurred in the short term. An enhanced neck and chest computed tomography (CT) showed a contrast agent leaked from the aberrant right subclavian artery to the esophagus. A pseudoaneurysm of the aberrant right subclavian artery and subclavian artery-esophageal fistula were diagnosed by CT angiography. Although false aneurysms developing after iatrogenic injury and trauma have been reported, those caused by esophageal stent placement because of esophageal stricture after endoscopic submucosal dissection have not. When persistent hemorrhage and progressive anemia develop after esophageal stent placement, an enhanced CT should be performed to exclude the false aneurysm.
一名67岁男性因早期食管鳞状细胞癌接受内镜黏膜下剥离术，后因吞咽困难入院。黏膜缺损超过周长的四分之三，切除瘢痕的远端边缘在8个月后形成狭窄。在经历保守治疗、探条扩张和食管支架置入后，患者吞咽障碍症状有所改善，但短期内出现持续出血和进行性贫血。颈部和胸部增强计算机断层扫描（CT）显示造影剂从异常右锁骨下动脉漏入食管。CT血管造影诊断为异常右锁骨下动脉假性动脉瘤和锁骨下动脉-食管瘘。虽然已有医源性损伤和创伤后发生假性动脉瘤的报道，但内镜黏膜下剥离术后因食管狭窄放置食管支架导致的假性动脉瘤尚未见报道。当食管支架置入后出现持续出血和进行性贫血时，应进行增强CT检查以排除假性动脉瘤。
