title: Upper gastrointestinal bleeding secondary to an aberrant right subclavian artery-esophageal fistula: a case report and review of the literature.
abstract: An aberrant right subclavian artery (ARSA) is a common aortic arch abnormality. A case of a 57-year-old man presenting with melena and hypotension secondary to an ARSA-esophageal fistula is reported. The current report is unique because it is the first reported case of ARSA-esophageal fistula associated with prior esophagectomy and gastric pull-up. A MedLine search was performed for ARSA-esophageal fistula cases, which were then compared with the present case. Because this patient had no vascular conduits, nasogastric or endotracheal tubes, the fistula likely occurred secondary to the previous surgery. This case is unusual because the patient survived the original hemorrhage associated with the ARSA-esophageal fistula. An ARSA-esophageal fistula is a rare, but potentially fatal cause of upper gastrointestinal bleeding. A high index of suspicion is needed to make the diagnosis. This condition should be considered in patients with risk factors combined with hemodynamically significant gastrointestinal bleeding.
authors.affiliation: Faculty of Medicine, University of Ottawa, Ottawa, Canada.
authors.forename: Adam
authors.initials: A
authors.lastname: Millar
authors.forename: Alaa
authors.initials: A
authors.lastname: Rostom
authors.forename: Pasteur
authors.initials: P
authors.lastname: Rasuli
authors.forename: Nav
authors.initials: N
authors.lastname: Saloojee
mesh_terms: D000785:Aneurysm, Infected / Q000150:complications; D001019:Aortic Rupture / Q000150:complications; D004937:Esophageal Fistula / Q000150:complications* / Q000175:diagnosis; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013348:Subclavian Artery / Q000002:abnormalities*; D016157:Vascular Fistula / Q000150:complications* / Q000175:diagnosis