Driveline erosion of the colon as a late complication of LVAD implantation

Abstract

A 69-year-old man with ischemic cardiomyopathy underwent left ventricular assist device (LVAD) implantation as destination therapy. One month after LVAD placement, the patient reported abdominal pain with driveline site purulence. Serial wound and blood cultures were positive for various Gram-positive and Gram-negative organisms. Abdominal imaging revealed a possible intracolonic course of the driveline at the splenic flexure, but there were no imaging findings suggestive of bowel perforation. A colonoscopy did not identify a perforation. The patient was treated with antibiotics but continued to experience driveline infections over the next 9 months until frank stool started draining from the driveline exit site. Our case illustrates driveline erosion of the colon causing the insidious formation of an enterocutaneous fistula and highlights a rare late complication of LVAD therapy.

Learning objective: Colonic erosion by the driveline can cause enterocutaneous fistula formation over a period of months. A change from typical infectious organisms for driveline infection should prompt investigation of a gastrointestinal source. In cases where computed tomography of the abdomen does not show perforation and there is concern for an intracolonic course of the driveline, colonoscopy or laparoscopy may be diagnostic.

Keywords: Complication; Driveline erosion; Fistula; Left ventricular assist device.

Fig. 1

Left ventricular assist device driveline exit site with feculent drainage at 9 months post-implantation consistent with an enterocutaneous fistula.

Fig. 2

Computed tomography of the abdomen and pelvis without contrast in (A) axial plane and (B) sagittal plane. In the region of the splenic flexure, the left ventricular assist device driveline courses inferiorly with a segment located within the lumen of the descending colon (arrows). There is no visualized fluid collection or fat stranding.