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择期腹腔镜胆囊切除术后的主动脉肠瘘

Aortoenteric fistula following elective laparoscopic cholecystectomy.

作者信息

Tupper-Ring Laura, Mills Lauren, McDonald Joey, Lightfoot Chris, Livingstone Scott, Jessula Samuel

机构信息

Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.

Division of Vascular Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.

出版信息

J Vasc Surg Cases Innov Tech. 2025 Feb 25;11(3):101761. doi: 10.1016/j.jvscit.2025.101761. eCollection 2025 Jun.

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.

摘要

我们报告了一例71岁女性患者,在接受择期腹腔镜胆囊切除术后21天出现胃肠道出血。初始影像学检查发现非动脉瘤性肾下腹主动脉假性动脉瘤,采用血管内支架移植物进行治疗。尽管进行了该手术,但胃肠道出血仍反复出现,促使进一步影像学检查,发现了合并移植物感染的主动脉肠瘘。该瘘管可能是由胆囊切除术期间套管针穿刺造成的医源性损伤引起的。确定性手术修复包括切除感染的移植物并用牛心包导管进行重建。本病例突出了主动脉肠瘘的诊断挑战、移植物感染风险以及选择重建导管时的注意事项。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9dbf/11994957/6831564145f9/gr1.jpg

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