Mediastinitis, pseudo-aneurysm formation, aortic bleed, and death from endoscopic botulinum toxin injection

Abstract

Endoscopic botulinum toxin injection is considered a safe and viable option for the management of achalasia [1] [2]. Although esophageal perforation and mediastinitis are well-documented complications of this treatment, pseudo-aneurysm formation of the thoracic aorta following inter-sphincteric injection is exceedingly rare [3]. We report the first published fatality from a thoracic aorta pseudo-aneurysm bleed following inter-sphincteric botulinum toxin injection. Endoscopists should be vigilant of this potentially fatal complication.