Fatal cardiac tamponade after emergency tension-free repair of a large paraesophageal hernia.
Paraesophageal hernia is an unusual disorder of the esophageal hiatus that may be associated with life-threatening mechanical problems. We report a case of a large paraesophageal hernia that presented with acute thoracic herniation and incarceration of the stomach. The patient underwent laparoscopic operation, including reduction of an intrathoracic stomach, hernial sac removal, and tension-free repair of the hiatus with polytetrafluoroethylene (PTFE) mesh. The mesh was fixed with a straight hernia stapler. Postoperatively the patient developed a fatal cardiac tamponade secondary to a coronary vein laceration due to fixation of the mesh with the stapler. Different operative techniques and possibilities for prevention of the complication are discussed.
Second Department of Surgery, Helsinki University Central Hospital, Haartmaninkatu 4, FI-00290 Helsinki, Finland. esko.kemppainen@huch.fi
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Kemppainen
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Kiviluoto
D000368:Aged; D000369:Aged, 80 and over; D002305:Cardiac Tamponade / Q000209:etiology* / Q000401:mortality*; D003331:Coronary Vessels / Q000293:injuries; D017809:Fatal Outcome; D005260:Female; D006551:Hernia, Hiatal / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D013528:Surgical Staplers / Q000009:adverse effects; D014680:Veins / Q000293:injuries