Fatal Esophago-aortal Fistulous Bleeding Following Feeding Tube “Rub-Raw” Lesion on an Anomalous Right Subclavian Artery

Abstract

This article provides a case report on a 45-year-old man with severe thoracic trauma after a traffic accident. Twenty-five days later, nontreatable esophago-aortal fistulous bleeding by a focal decubital fricton (“rub-raw”) lesion occurred, caused by feeding tube treatment after 14 days. An abnormal right subclavian artery was responsible for the complication. Arterial bleedings after 3 weeks of feeding tube treatment is pathognomonic for patients with an anomalous right subclavian artery. The bleeding can only be controlled for a short time by a Sengstaken-Blakemore tube. Pathogenesis, avoidance, and medical/legal aspects are discussed.