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Aortoesophageal Fistula in a Child With Undiagnosed Vascular Ring: Life-Threatening or Lethal?

Nicholas S Clarke1, Raghav Murthy1, Jennifer Hernandez2

  • 1Division of Pediatric Cardiothoracic Surgery, University of Texas Southwestern Medical Center and Children's Medical Center, Dallas, Texas.

The Annals of Thoracic Surgery
|September 21, 2016
PubMed

Insights

A foreign body caused a life-threatening aortoesophageal fistula in a boy with a vascular ring. Successful resuscitation and surgical repair were achieved, highlighting a rare pediatric emergency management case.

Area of Science:

  • Pediatric Surgery
  • Cardiovascular Surgery
  • Gastroenterology

Background:

  • Vascular rings are congenital anomalies that can predispose to esophageal and aortic complications.
  • Foreign body impaction in the esophagus is a known cause of aortoesophageal fistula, a rare and catastrophic event.
  • Aortoesophageal fistula presents with severe upper gastrointestinal bleeding, often leading to hemodynamic instability.

Observation:

  • A 6-year-old boy presented with exsanguinating hematemesis due to an aortoesophageal fistula.
  • The fistula was caused by an impacted foreign body in the esophagus.
  • The patient had an underlying vascular ring anomaly.

Findings:

  • Successful resuscitation of the patient in extremis was achieved.
  • Surgical repair of the aortoesophageal fistula was performed successfully.
  • The management involved a multidisciplinary approach addressing both the fistula and the vascular ring.

Implications:

  • This case highlights the critical importance of prompt diagnosis and aggressive management in pediatric patients with aortoesophageal fistula.
  • Early recognition of foreign body impaction as a cause of fistula is crucial.
  • Successful repair in complex cases underscores the feasibility of surgical intervention even in critically ill children with vascular anomalies.

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