Published online Jun 27, 2014. doi: 10.4240/wjgs.v6.i6.117
Revised: April 2, 2014
Accepted: May 29, 2014
Published online: June 27, 2014
Processing time: 178 Days and 16.7 Hours
A fistula formation between the esophagus and an aberrant right subclavian artery is a rare but fatal complication that has been mostly described in the setting of prolonged nasogastric intubation and foreign body erosion. We report a case of a young morbidly obese patient who underwent sleeve gastrectomy that was complicated by a postoperative leak at the level of the gastroesophageal junction. A covered esophageal stent was placed endoscopically to treat the leak. The patient developed massive upper gastrointestinal bleeding secondary to the erosion of the stent into an aberrant retroesophageal right subclavian artery twelve days after stent placement. She was ultimately treated by endovascular stenting of the aberrant right subclavian artery followed by thoracotomy and esophageal repair over a T-tube. This case report highlights the multidisciplinary approach needed to diagnose and manage such a devastating complication. It also emphasizes the need for imaging studies prior to stent deployment to delineate the vascular anatomy and rule out the possibility of such an anomaly in view of the growing popularity of esophageal stents, especially in the setting of a leak.
Core tip: The use of esophageal covered stents to treat leaks following sleeve gastrectomy has increased significantly over the past years. However, their possible complications have not yet been fully explored. As demonstrated by our case report, the presence of an aberrant retroesophageal Subclavian artery can predispose to the formation of a fistula with the esophagus secondary to stent erosion, thereby leading to catastrophic hemorrhage and death. Our approach in this case was to start with stent angioplasty of the Subclavian artery followed by thoracotomy and esophageal repair over a T-tube and this approach proved successful in saving the patient’s life.