Midthoracic Pain, Sentinel Arterial Haemorrhage and Exsanguination after a Symptom-Free Interval (Chiari's Triad) is Diagnostic of Arterio-Oesophageal Fistula: A Life-Threatening Cause of Gastrointestinal Bleeding

Andra Glodean; Rainer Grobholz; Karim El-Hag; Mairi Ziaka; Jean-Paul Schmid

doi:10.12890/2021_002134

Midthoracic Pain, Sentinel Arterial Haemorrhage and Exsanguination after a Symptom-Free Interval (Chiari's Triad) is Diagnostic of Arterio-Oesophageal Fistula: A Life-Threatening Cause of Gastrointestinal Bleeding

Eur J Case Rep Intern Med. 2021 Feb 23;8(3):002134. doi: 10.12890/2021_002134. eCollection 2021.

Authors

Andra Glodean¹, Rainer Grobholz^{2

3}, Karim El-Hag¹, Mairi Ziaka¹, Jean-Paul Schmid^{1

4}

Affiliations

¹ Department of Internal Medicine, Clinic Barmelweid, Barmelweid, Switzerland.
² Institute of Pathology, Cantonal Hospital Aarau, Aarau, Switzerland.
³ Medical Faculty, University of Zurich, Zurich, Switzerland.
⁴ Medical Faculty, University of Bern, Bern, Switzerland.

Abstract

Introduction: Arterio-oesophageal fistulae are a very uncommon cause of severe gastrointestinal bleeding, and mostly result from an aberrant right subclavian artery and mediastinal surgery or prolonged endotracheal/nasogastric intubation.

Material and methods: We present the case of a patient with an oesophageal adenocarcinoma and haematemesis due to a subclavian arterio-oesophageal fistula after mediastinal radiotherapy.

Conclusion: We discuss the rare, life-threatening condition of acute erosion of the left subclavian artery caused by an oesophageal tumour and presenting with Chiari's triad.

Learning points: Subclavian arterio-oesophageal fistula is an uncommon, life-threatening cause of gastrointestinal bleeding.Knowledge of Chiari's triad enables early recognition of potentially fatal gastro-intestinal bleeding.A high level of suspicion is essential for prompt diagnosis and referral for surgical treatment especially in patients with malignancies of the upper gastrointestinal tract.

Keywords: Chiari’s triad; Subclavian arterio-oesophageal fistula; exsanguination; gastrointestinal bleeding; oesophageal carcinoma; sentinel arterial haemorrhage.