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.
Kemppainen
E
E
Second Department of Surgery, Helsinki University Central Hospital, Haartmaninkatu 4, FI-00290 Helsinki, Finland. esko.kemppainen@huch.fi
Kiviluoto
T
T
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