• Maiko Watanabe, Kei Suzuki, Kazuhisa Fujinaga, Akitaka Yamamoto, Masaki Fujioka, Naoyuki Katayama, and Hiroshi Imai.
• The Emergency and Critical Care Center Mie University Hospital Tsu Mie Japan.
• Acute Med Surg. 2016 Apr 1; 3 (2): 139-142.

CaseAberrant right subclavian artery-esophageal fistula is a rare, but fatal, complication. A 55-year-old febrile man with a nasogastric feeding tube developed sudden massive hematemesis and shock.OutcomeUpper endoscopy revealed an intragastric hematoma with no active bleeding observed except for oozing from an esophageal tear. Enhanced computed tomography scan detected aberrant right subclavian artery but was unable to determine the bleeding source. Repeat endoscopy carried out on day 2 confirmed hemostasis and the disappearance of the intragastric hematoma. However, the patient suddenly developed recurrent massive hematemesis with refractory shock on day 4 and died. Postmortem computed tomography revealed endoscopic clips in contiguity with aberrant right subclavian artery; a final diagnosis of aberrant right subclavian artery-esophageal fistula was made.ConclusionOur case demonstrates aberrant right subclavian artery-esophageal fistula may present with transient spontaneous hematemesis in a state of shock, possibly related to fever of unknown origin, and is challenging to diagnose by repeated endoscopy once hematemesis develops.

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