Cardiomediastinal tamponade and shock following three-stage transthoracic oesophagectomy.
Massive gastric tube dilatation causing cardiomediastinal tamponade is an unusual cause of obstructive shock after transthoracic oesophagectomy. A 55-year-old female was operated for total transthoracic oesophagectomy. Twelve hours after the surgery, she developed hypotension and raised central venous pressure unresponsive to fluid infusion and ionotropes. X-ray chest showed a massively dilated stomach, which was causing intrathoracic tamponade. Suction applied to the nasogastric tube led to aspiration of 150-200 ml of fluid and a large volume of air, which led to resolution of the haemodynamic instability. A simple manoeuvre like nasogastric suction in postoperative case of oesophagectomy can serve as a diagnostic as well as therapeutic tool. It must be performed before resorting to invasive and expensive examination or intervention.
Cherian
V
V
Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital, Parel, Mumbai - 400 012, India.
Divatia
J V
JV
Kulkarni
A
A
Dasgupta
D
D
D001794:Blood Pressure; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D002305:Cardiac Tamponade / Q000175:diagnosis / Q000209:etiology*; D003937:Diagnosis, Differential; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy; D005260:Female; D006801:Humans; D007022:Hypotension / Q000209:etiology*; D008875:Middle Aged; D011183:Postoperative Complications; D013396:Suction