Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 7, 2019; 25(17): 2144-2148
Published online May 7, 2019. doi: 10.3748/wjg.v25.i17.2144
Tuberculous esophagomediastinal fistula with concomitant mediastinal bronchial artery aneurysm-acute upper gastrointestinal bleeding: A case report
Sultan R Alharbi
Sultan R Alharbi, Interventional Radiology Unit, King Saud University Medical City, Collage of Medicine, King Saud University, Riyadh 11472, Saudi Arabia
Author contributions: Alharbi SR involved in diagnosis and treatment of the patient and after that review the literature and write the manuscript.
Informed consent statement: Informed consent was obtained from the patient for the publication of the report.
Conflict-of-interest statement: The authors have declared no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Sultan R Alharbi, MD, Assistant Professor, Doctor, Interventional Radiology Unit, King Saud University Medical City, Collage of Medicine, King Saud University, PO Box 7805, King Abdullah Street, Riyadh 11451, Saudi Arabia. drsultan000@gmail.com
Telephone: +966-11-4761112
Received: February 16, 2019
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
Abstract
BACKGROUND

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.

CASE SUMMARY

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.

CONCLUSION

We successfully treated a patient with acute upper GI bleeding due to tuberculous esophagomediastinal fistula and mediastinal bronchial artery aneurysm using transcatheter coil embolization.

Keywords: Mediastinal bronchial artery aneurysm; Esophagomediastinal fistula; Upper gastrointestinal bleeding; Mediastinal tuberculosis; Case report

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.