[Erosion hemorrhage from an esophago-aortic fistula in congenital anomaly of the thoracic aorta as a fatal complication of a stomach tube].
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.


CONCLUSIONS
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.
D001013:Aorta, Thoracic / Q000002:abnormalities*; D001018:Aortic Diseases / Q000209:etiology*; D002648:Child; D004937:Esophageal Fistula / Q000209:etiology*; D005402:Fistula / Q000209:etiology*; D006470:Hemorrhage / Q000209:etiology*; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000009:adverse effects*; D008297:Male
Arrosionsblutung aus ösophagoaortaler Fistel bei kongenitaler Anomalie der thorakalen Aorta als tödliche Komplikation einer Magensonde.