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Aortoenteric fistula following elective laparoscopic cholecystectomy
Laura Tupper-Ring1, Lauren Mills1, Joey McDonald2
1Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
Journal of Vascular Surgery Cases and Innovative Techniques
|April 15, 2025
Summary
A rare case of aortoenteric fistula, a serious complication after laparoscopic cholecystectomy, led to gastrointestinal bleeding. Prompt diagnosis and surgical repair involving endograft removal and reconstruction were crucial for patient recovery.
Area of Science:
- Vascular Surgery
- Gastroenterology
- Surgical Complications
Background:
- Laparoscopic cholecystectomy is a common procedure.
- Aortoenteric fistulas are rare but life-threatening complications.
- Endovascular stent grafts are used to treat aortic pathologies.
Observation:
- A 71-year-old woman presented with gastrointestinal bleeding 21 days post-laparoscopic cholecystectomy.
- Initial imaging revealed an infrarenal aortic pseudoaneurysm treated with an endovascular stent graft.
- Recurrent bleeding led to the diagnosis of an aortoenteric fistula with endograft infection.
Findings:
- The aortoenteric fistula was likely iatrogenically caused by trocar injury during surgery.
- Endograft infection complicated the pseudoaneurysm and fistula.
- Successful definitive management involved infected endograft resection and bovine pericardium conduit reconstruction.
Implications:
- This case underscores the diagnostic difficulties associated with aortoenteric fistulas.
- It highlights the risk of endograft infection following aortic interventions.
- Careful consideration of conduit material is essential for complex aortic reconstructions.
