[Erosion hemorrhage from an esophago-aortic fistula in congenital anomaly of the thoracic aorta as a fatal complication of a stomach tube].

UNLABELLED: A 6 year old boy was admitted to ICU because of severe polytrauma. He was ventilated for 4 weeks using a nasotracheal tube (high-volume-low-pressure cuff) and fed by nasogastric tube for 6 weeks. After this time severe haemorrhage from the oesophagus occurred, caused by an oesophago-aortic fistula. Bleeding could be stopped by a Sengstaken-Blakemore-tube. The child died during emergency thoracotomy as a result of ventricular fibrillation after clamping of the aorta. Autopsy revealed a malformation of the aortic arch (type II B 4a according to Kirklin and Clagett 1950). This vascular ring had been the site of a pressure necrosis of the oesophagus due to the nasogastric tube. Finally an erosion of the aortic malformation (a. lusoria) had been the result.

CONCLUSIONS: Malformation of the aortic arch sometimes can be suspected by x-ray of the chest: right-sided shadow of the ascending aorta. If severe arterial bleeding from the oesophagus occurs, one should think of this malformation. A Sengstaken-Blakemore-tube can be a useful emergency method for temporary stopping of haemorrhage.