Aortoenteric fistula following elective laparoscopic cholecystectomy

Abstract

We present the case of a 71-year-old woman with gastrointestinal bleeding 21 days after undergoing elective laparoscopic cholecystectomy. Initial imaging revealed a pseudoaneurysm of nonaneurysmal infrarenal aorta, managed with an endovascular stent graft. Despite this procedure, recurrent gastrointestinal bleeding persisted, prompting further imaging that identified an aortoenteric fistula complicated by endograft infection. The fistula likely resulted from an iatrogenic injury caused by trocar entry during the cholecystectomy. Definitive surgical repair involved resection of the infected endograft and reconstruction with a bovine pericardium conduit. This case highlights the diagnostic challenges of aortoenteric fistulas, endograft infection risks, and considerations in selecting conduits for reconstruction.

Keywords: Aortoentric fistula; Bovine graft; Iatrogenic injury.

Fig 1

False aneurysm. (A) Coronal multiplayer reformat (MPR). (B) Volume-rendered arterial phase. (C) Axial MPR. (D) Completion angiogram after endograft deployment.

Fig 2

Key events and timeline of case report after cholecystectomy. CT, computed tomography.

Fig 3

(A) Axial oblique demonstrating fistula from duodenum to the aorta with stent graft in place. (B) Axial computed tomography scan with gas outside the stent graft, but withing native aortic sac and false aneurysm posterior. (C) Sagittal multiplayer reformat showing the anterior gas and posterior false aneurysm. (D) Virtual reality image with stent graft and false aneurysm posteroinferior.

Fig 4

Conduit using a sheet of bovine pericardium, folded onto itself, and tubularized with an endo-GIA stapler using a vascular staple load.