Esophageal stenosis after coil embolization of an aortopulmonary collateral artery: report of a very unusual cause.
A 10-year-old boy who had previously undergone surgery for tetralogy of Fallot, pulmonary atresia, and ventricular septal defect was admitted with difficulty in swallowing and significant failure to thrive. His history included that he had 2 angiographically detected aberrant pulmonary arteries extending from the descending aorta to the right and left lungs, respectively. Both collaterals had been ligated during the corrective surgery; however, early postoperative evaluation revealed that the vessel that crossed behind the esophagus to the left lung had become recanalized. Coil embolization was performed to occlude this collateral. The patient had begun to develop swallowing difficulties 2 years after the embolization. Esophagography revealed a significant stricture in the middle of the esophagus, just anterior to the location of the coil in the vessel behind. The patient underwent a program of esophageal dilatation. This was successful, and he regained normal swallowing ability. To our knowledge, no similar case of esophageal stenosis has been reported in the English literature. We believe that inflammation surrounding the coiled aberrant artery, presumably caused by injury during the corrective surgery and resulting in hemorrhage, led to fibrosis around the vessel. This fibrosis also involved the adjacent esophageal wall, thus causing progressive stenosis.
Arda
Irfan Serdar
IS
Department of Pediatric Surgery, Baskent University Faculty of Medicine, 06490 Bahçelievler Ankara, Turkey. serdara@baskent-ank.edu.tr <serdara@baskent-ank.edu.tr>
Guney
Lutfi Hakan
LH
Coskun
Mehmet
M
Hiçsönmez
Akgün
A
D002648:Child; D003097:Collateral Circulation; D003680:Deglutition Disorders / Q000209:etiology; D004621:Embolization, Therapeutic / Q000009:adverse effects*; D004940:Esophageal Stenosis / Q000209:etiology*; D005355:Fibrosis; D006801:Humans; D007249:Inflammation; D008297:Male; D011651:Pulmonary Artery / Q000002:abnormalities*; D013771:Tetralogy of Fallot / Q000601:surgery