Bedside placement of an aortic occlusion balloon to control a ruptured aorto-esophageal fistula in a small child.
A child had a percutaneous endoscopic gastrostomy tube removed by transecting it at skin level. The internal portion ("the bolster") was allowed to pass in the GI tract. She subsequently had odynophagia. Magnetic resonance imaging identified a foreign body within the lower thoracic esophagus. During esophagoscopy, the bolster was removed. The following morning, she had massive hematemesis with cardiovascular collapse. As an emergent maneuver, an intra-aortic balloon was percutaneously deployed at the bedside without fluoroscopic guidance. This temporized the exsanguination. Subsequent intraoperative aortography confirmed an aortoesophageal fistula. A stent-graft was deployed with immediate hemodynamic stabilization. She later underwent esophageal resection and recovered well.
Hill
Sarah J
SJ
Department of Surgery, Emory University, Atlanta, GA, USA.
Zarroug
Abdalla E
AE
Ricketts
Richard R
RR
Veeraswamy
Ravi
R
D001018:Aortic Diseases / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D001019:Aortic Rupture / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D021721:Balloon Occlusion; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation; D002648:Child; D020878:Device Removal; D004937:Esophageal Fistula / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D016629:Esophagectomy; D004945:Esophagoscopy; D005260:Female; D005548:Foreign-Body Migration / Q000209:etiology / Q000628:therapy*; D005774:Gastrostomy / Q000009:adverse effects* / Q000295:instrumentation; D006396:Hematemesis / Q000209:etiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D012769:Shock / Q000209:etiology; D015607:Stents; D013908:Thoracotomy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D016157:Vascular Fistula / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*