Traumatic Aortic and Celiac Pseudoaneurysm with Aortocaval Fistula Managed with Endovascular Aortic Cuff Deployment and Open Hepatic Revascularization.

We present the case of a young patient who sustained a gunshot wound to the abdomen initially treated with laparotomy and repair of small bowel, splenic vein and diaphragmatic injuries. Subsequent computed tomography (CT) performed for hemodynamic instability demonstrated a pseudoaneurysm involving the aorta and proximal celiac artery, with an associated aortocaval fistula. An attempt at transperitoneal repair of these injuries was aborted due to extensive inflammatory changes in the region encountered during exposure. Subsequently, a hybrid repair was performed. This consisted of exclusion of the aortic and celiac artery pseudoaneurysm using an endovascular aortic cuff (22 × 39 mm, Cook Medical) via infrarenal aortic access, surgical ligation of the celiac artery branches, and revascularization via bypass from the infrarenal aortic access site arteriotomy to the common hepatic artery.

Large mediastinal haematoma after paraoesophageal hernia repair.

Mediastinal haematoma is a rare complication of laparoscopic paraoesophageal hernia repair with few documented cases in the current literature. Presentation of this unique clinical problem can range from extrinsic oesophageal obstruction to life-hreatening cardiac tamponade and therefore, warrants further discussion of at-risk population aetiology, diagnosis and successful management strategies. We present the case of a 71-year-old woman who underwent laparoscopic paraoesophageal hernia repair with nissen fundoplication complicated by severe dysphagia on postoperative day 12. Further evaluation with oesophagram and CT imaging revealed a large mediastinal haematoma with near obstruction of the distal oesophagus. This was managed successfully with laparoscopic transhiatal washout and drainage.