Aparato Digestivo, Complejo Hospitalario Universitario de A Coruña, España.
Aparato Digestivo, Complejo Hospitalario Universitario de A Coruña.
Rev Esp Enferm Dig. 2021 Sep;113(9):687. doi: 10.17235/reed.2021.7811/2021.
A 50-year-old patient with a history of hypopharyngeal cancer, laryngectomy, adjuvant chemoradiotherapy and incompetent tracheoesophageal fistula was admitted for elective pharingostomal surgery. During the surgery, he presented esophageal bleeding with hemodynamic instability. After stabilization, a gastroscopy was performed through the stoma, showing arterial bleeding 4-5 cm distal to the stoma, which was controlled with three hemostatic clips. After four hours, the patient presented a new episode of bleeding with hemodynamic instability and a Sengstaken-Blakemore tube was placed that stopped the bleeding. Computed tomography angiography (CT angiography) was performed, which showed an aberrant right subclavian artery with a retroesophageal pathway, in close contact with the area where the clips were placed. An endovascular stent was placed in the right subclavian artery with control of the bleeding after removal of the Sengstaken-Blakemore tube. The patient was discharged seven days later.
一位 50 岁的患者，有下咽癌病史、喉切除术、辅助放化疗和气管食管瘘，因择期行咽吻合口手术入院。手术中出现食管出血伴血流动力学不稳定。稳定后，经造口行胃镜检查，显示距造口 4-5cm 处动脉出血，用三个止血夹控制出血。四小时后，患者再次出现出血伴血流动力学不稳定，放置 Sengstaken-Blakemore 管止血。行 CT 血管造影（CTA）检查，显示右锁骨下动脉异常，有食管后路径，与放置夹的部位密切接触。在移除 Sengstaken-Blakemore 管后，在右锁骨下动脉内放置血管内支架，控制出血。患者 7 天后出院。
