Subclavian Arterio-Esophageal Fistula Secondary to Fish Bone Impaction: Report of a Case

A 48-year-old Indian man swallowed a fish bone and presented 1 week later with dysphagia, following a single epi- sode of fresh hematemesis. A barium swallow demonstrated a horizontal mucosal tear at the level of the aortic arch, and computed tomography (CT) showed mediastinal emphysema and a bleeding point medial to the left subclavian artery which appeared to be contained by a surrounding hematoma. Subse- quently, he developed sudden massive hematemesis and col- lapsed. Despite emergency surgery, the patient died. At the postmortem examination, a 1.2-cm fistula tract was found con- necting the esophagus to the left subclavian artery. This case report emphasizes that a diagnosis of arterio-esophageal fistula should be considered if a patient presents with fresh hematemesis and a recent history of foreign body ingestion.