Jungck E, Püschel K
Anaesthesist. 1983 Oct;32(10):498-500.
A 6 year old boy was admitted to ICU because of severe polytrauma. He was ventilated for 4 weeks using a nasotracheal tube (high-volume-low-pressure cuff) and fed by nasogastric tube for 6 weeks. After this time severe haemorrhage from the oesophagus occurred, caused by an oesophago-aortic fistula. Bleeding could be stopped by a Sengstaken-Blakemore-tube. The child died during emergency thoracotomy as a result of ventricular fibrillation after clamping of the aorta. Autopsy revealed a malformation of the aortic arch (type II B 4a according to Kirklin and Clagett 1950). This vascular ring had been the site of a pressure necrosis of the oesophagus due to the nasogastric tube. Finally an erosion of the aortic malformation (a. lusoria) had been the result.
Malformation of the aortic arch sometimes can be suspected by x-ray of the chest: right-sided shadow of the ascending aorta. If severe arterial bleeding from the oesophagus occurs, one should think of this malformation. A Sengstaken-Blakemore-tube can be a useful emergency method for temporary stopping of haemorrhage.
一名6岁男孩因严重多发伤入住重症监护病房。他使用鼻气管插管（大容量低压袖带）通气4周，并通过鼻胃管喂养6周。此后，因食管主动脉瘘导致食管严重出血。出血可通过Sengstaken - Blakemore管止血。患儿在紧急开胸手术中因主动脉钳夹后心室颤动死亡。尸检显示主动脉弓畸形（根据Kirklin和Clagett 1950年分类为II B 4a型）。这个血管环是由于鼻胃管导致食管受压坏死的部位。最后导致主动脉畸形（迷走主动脉）糜烂。
主动脉弓畸形有时可通过胸部X线怀疑：升主动脉右侧阴影。如果发生严重的食管动脉出血，应考虑这种畸形。Sengstaken - Blakemore管可能是暂时止血的有用紧急方法。
