[Acute myopericarditis following laparoscopic treatment of gastroesophageal reflux].
A 32-year-old patient experienced a postoperative acute myopericarditis following laparoscopic surgery for gastro-oesophageal reflux (Toupet's fundoplication). His medical history was unremarkable, apart from controlled arterial hypertension. Peroperative circulation was stable, except a short hypertensive episode at CO2 insufflation, controlled with nicardipine. A myopericarditis occurred at the fourth postoperative hour, with apical and inferior hypokinesia at ventriculography, ST-segment elevation with unremarkable coronary arteriography. The patient was discharged at day seven, with a NSAIDs treatment. Echocardiography three and nine months later postoperatively, showed an apical akinesia and persistence of the ST-segment modification, without clinical symptoms. Complications of laparoscopic fundoplication is either specific to surgery (gastro-oesophageal injury, diaphragmatic injury, mediastinitis, stenosis) or secondary to pneumoperitoneum (pneumothorax, carbon dioxide embolism). In this case, following an apparently uncomplicated laparoscopy and, except a direct cardiac trauma from a laparoscopic instrument, either coronary artery spasm, or pneumopericardium with CO2, or delayed gas embolism, or preoperative "silent" myopericarditis could be the potential cause of this cardiac complication.
Boccara
G
G
Département d'anesthésie-réanimation B, hôpital Saint-Eloi, CHRU Montpellier, France.
Lopez
S
S
Huguet
M
M
Mann
C
C
Colson
P
P
D000208:Acute Disease; D000328:Adult; D002245:Carbon Dioxide; D017023:Coronary Angiography; D004452:Echocardiography; D004562:Electrocardiography; D005500:Follow-Up Studies; D018662:Fundoplication / Q000009:adverse effects*; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006801:Humans; D006973:Hypertension / Q000150:complications; D007327:Insufflation / Q000009:adverse effects; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D009200:Myocardial Contraction / Q000502:physiology; D009205:Myocarditis / Q000209:etiology*; D010493:Pericarditis / Q000209:etiology*
D002245:Carbon Dioxide
Myopéricardite aiguë dans les suites d'une cure laparoscopique de reflux gastro-oesophagien.