Massive upper gastrointestinal bleeding caused by an intercostal arterio-esophageal fistula: A rare case report

Acute upper gastrointestinal bleeding caused by esophageal right bronchial artery fistula: A case report

BACKGROUND

Fistula between the esophagus and bronchial artery is an extremely rare and potentially life-threatening cause of acute upper gastrointestinal bleeding. Here, we report a case of fistula formation between the esophagus and a nonaneurysmal right bronchial artery (RBA).

CASE SUMMARY

An 80-year-old woman with previous left pneumonectomy and recent placement of an uncovered self-expandable metallic stent for esophageal adenocarcinoma was admitted due to hematemesis. Emergent computed tomography showed indirect signs of fistulization between the esophagus and a nonaneurysmal RBA, in the absence of active bleeding. Endoscopy revealed the esophageal stent correctly placed and a moderate amount of red blood within the stomach, in the absence of active bleeding or tumor ingrowth/overgrowth. After prompt multidisciplinary evaluation, a step-up approach was planned. The bleeding was successfully controlled by esophageal restenting followed by RBA embolization. No signs of rebleeding were observed and the patient was discharged home with stable hemoglobin level on postoperative day 7.

CONCLUSION

This was a previously unreported case of an esophageal RBA fistula successfully managed by esophageal restenting followed by RBA embolization.

Endovascular Management of Gastric Conduit Hemorrhage following Transthoracic Esophagectomy

Seven patients underwent angiography and attempted embolization for massive hemorrhage of the gastric conduit after transthoracic esophagectomy. Endoscopy revealed ulcers in 5 patients, tumor recurrence in 1 patient, and unknown etiology in 1 patient. Arteriography revealed extravasation, pseudoaneurysm, or tumor blush arising from the intercostal artery (n = 4) or right gastric artery (n = 2), which were successfully embolized. The bleeding source was not identified in 1 patient, who died from persistent hemorrhage.