Published online May 7, 2019. doi: 10.3748/wjg.v25.i17.2144
Peer-review started: February 18, 2019
First decision: March 14, 2019
Revised: March 29, 2019
Accepted: April 19, 2019
Article in press: April 20, 2019
Published online: May 7, 2019
Processing time: 79 Days and 10.7 Hours
Esophagomediastinal fistula is a very rare complication of tuberculosis in otherwise healthy adults, and mediastinal bronchial artery aneurysm is even rarer. In this case report, we describe a rare case of tuberculosis complication that presented with acute upper gastrointestinal (GI) bleeding. It also highlights the benefits of chest computed tomography (CT) as an excellent adjunct diagnostic tool to endoscopy and bronchoscopy and the role of trans-arterial embolization as a minimal invasive therapy alternative to surgery.
A 19-year-old medically free male patient presented with acute multiple episodes of hematemesis for 1 d. Upper GI endoscopy, bronchoscopy, and chest CT with IV contrast confirmed esophagomediastinal fistula with mediastinal bronchial artery aneurysm. After resuscitating patient with IV fluid and blood product transfusion, trans catheter embolization was performed for mediastinal bronchial artery aneurysm.
We successfully treated a patient with acute upper GI bleeding due to tuberculous esophagomediastinal fistula and mediastinal bronchial artery aneurysm using transcatheter coil embolization.
Core tip: A 19-year-old medically free male patient presented with acute upper gastrointestinal bleeding. He underwent endoscopy, bronchoscopy, and chest computed tomography with IV contrast. Diagnosis of pulmonary and mediastinal tuberculosis with esophagomediastinal fistula and mediastinal bronchial artery aneurysms was made. Patient was successfully treated with mediastinal bronchial artery aneurysm coil embolization and antitubercular medications.