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
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Article info
Publication history
Published online: February 09, 2023
Accepted:
January 18,
2023
Received in revised form:
January 3,
2023
Received:
November 20,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
