Aortoesophageal fistula in a 13-yr-old girl: complication after nasogastric tube placement in the setting of right-sided aortic arch

A case of fatal internal jugular vein perforation during nasogastric tube insertion

Nasogastric tube (NGT) insertion is a routine procedure in the management of surgical patients. We report the second case of internal jugular vein perforation during NGT insertion. A 79-year-old man presented with diffuse abdominal pain secondary to a perforated viscus. Abdominal CT revealed pneumoperitoneum, necessitating emergent exploratory laparotomy. On post-operative Day 7, the patient developed mild abdominal distension and subjective nausea for which NGT placement was ordered for decompression. Tube placement was confirmed by insufflation of air without aspiration of gastric contents. Output from the NGT upon placement revealed frank blood. The patient then developed respiratory distress requiring intubation, followed by a fatal arrhythmia. Post-mortem exam revealed the trajectory of the NGT through the pharyngeal wall into the right internal jugular vein. This case illustrates the importance of systematic evaluation of all procedures, as the outcome resulted from failure to recognize the initial error in tube placement.

[Esophageal perforation during nasogastric tube insertion in a patient with right-sided aortic arch and thoracic aorta. Pathophysiology and surgical implications]

Esophageal perforation during nasogastric tube insertion is a very unusual occurrence. In this case report, radiologic images revealed a right-sided aortic arch with a right-sided thoracic aorta. This anatomical anomaly probably contributed to the complication and necessitated a modified approach to the surgical repair.

Successful surgical treatment of a 4-month infant after exsanguination for aortoesophageal fistula

We report on the case of a 4-month infant in hypovolemic shock for severe digestive hemorrhage 38 days after surgical treatment of a double aortic arch who underwent a successful emergency thoracotomy for suspicion of an aortoesophageal fistula.

Aortoesophageal fistula--an unusual complication of esophagitis caused by Dieffenbachia ingestion

Aortoesophageal fistula (AEF) is a rare and mostly lethal cause of upper gastrointestinal bleeding in children. We report a successful outcome of surgical treatment after resuscitation of a girl aged 12 1/2 years with AEF as a complication of esophagitis caused by Dieffenbachia ingestion. The girl ate a leaf of Dieffenbachia picta in a suicidal attempt. After 5 weeks of medical treatment of esophagitis, small blood-stained vomitus and melena appeared. Within a few hours, it was followed by a massive gastrointestinal bleeding leading to exsanguination. The girl survived despite the pitfalls in clinical presentation and errors in diagnostic approach and treatment. Emergency exploration of cervical esophagus, followed by laparotomy and thoracotomy, was performed in attempt to find the source of bleeding and to control it. Aortoesophageal fistula was located between the ascending aorta near the origin of the brachiocephalic trunk and thoracic esophagus. Resection of the fistula led to prompt circulatory stabilization. The common houseplant, Dieffenbachia picta, causes edematous swelling of mucus membranes when chewed. Dieffenbachia-caused esophagitis is very rare and this etiology of AEF has not been reported in children.

Aortoesophageal fistula as a complication of Montgomery salivary bypass tube

The authors describe a 2-year-old girl with a right-sided aortic arch who developed a sudden, fatal aortoesophageal fistula after prolonged placement of Montgomery salivary bypass tubes in the distal esophagus.