Diffuse intrinsic pontine glioma with aberrant right subclavian artery–esophageal fistula induced by nasogastric tube

Abstract

An aberrant right subclavian artery (ARSA)–esophageal fistula is rare but highly fatal. A 4-year-old female patient with diffuse intrinsic pontine glioma presented with sudden massive hematemesis. Upper gastrointestinal endoscopy revealed massive pulsing bleeding from an ulcer in contact with a nasogastric tube (NGT) in the upper esophagus. A balloon in the esophagus stopped the bleeding temporally, and computed tomography revealed an ARSA–esophageal fistula. Transarterial embolization (TAE) stopped the bleeding completely, and she was saved. This is the first case of a pediatric cancer patient of its kind. Mucosal damage induced by chemotherapy might contribute to fistular development. Furthermore, this is the first report of a successful rescue of a patient with an ARSA–esophageal fistula by TAE. Therefore, we suggest evaluating the existence of ARSA in pediatric cancer patients with NGT insertion and treated with chemotherapy. TAE is effective in stopping the bleeding from an ARSA–esophageal fistula.