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Laparoscopic Splenectomy with Pericardial Devascularization for Hypersplenism and Esophageal Variceal Hemorrhage Due to Portal Hypertension
04:00

Laparoscopic Splenectomy with Pericardial Devascularization for Hypersplenism and Esophageal Variceal Hemorrhage Due to Portal Hypertension

Published on: November 15, 2024

[Three cases of esophageal bleeding after cardiovascular surgery]

Yasuhiko Watanabe1, Makoto Kosaka

  • 1Department of Anesthesiology, Osaka Prefectural General Medical Center, Osaka.

Masui. the Japanese Journal of Anesthesiology
|September 20, 2005
PubMed

Insights

Aberrant subclavian artery (ASCA) can cause severe esophageal bleeding in patients with prolonged nasogastric tube use after cardiovascular surgery. Early identification and prevention are crucial to avoid this serious complication.

Area of Science:

  • Cardiovascular Surgery
  • Vascular Anomalies
  • Gastrointestinal Complications

Background:

  • Aberrant subclavian artery (ASCA) is a common congenital anomaly of the aortic arch.
  • Patients undergoing cardiovascular surgery may require prolonged intubation.
  • Nasogastric tubes are frequently used in postoperative care.

Observation:

  • Three patients developed severe esophageal bleeding post-cardiovascular surgery.
  • All patients had a diagnosed aberrant subclavian artery (ASCA).
  • Prolonged intubation with nasogastric or ileus tubes was noted in these patients.

Findings:

  • Compression of the ASCA by nasogastric/ileus tubes led to ASCA-esophageal fistula formation.
  • This fistula resulted in severe esophageal bleeding.
  • The aberrant subclavian artery's anatomical course predisposes it to compression.

Implications:

  • Patients with ASCA are at increased risk for esophageal bleeding with prolonged nasogastric tube use.
  • Awareness of this ASCA complication is vital for surgical and medical teams.
  • Preventive strategies, including careful tube management, are essential to mitigate this risk.

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