title: Implantation of a total abdominal mesh plastic ending up in multiple, lethal right heart injuries.
abstract: We present the case of a 62-year old patient who had an elective surgery to implant a total abdominal plastic mesh due to massive herniation after prior lower body gun shots and deep wound infections. Twenty-four hours after the operation, the patient's condition deteriorated, ST-deviation occurred and the Troponin I test was positive. On admission, the patient needed moderate catecholamine therapy and echocardiography showed a pericardial effusion (>3 cm). Puncture of the effusion was impossible due to the plastic mesh and the patient was transferred to the operating room. A subxiphoidal pericardial incision was performed and 800 ml of fresh blood was drained. Despite this, the patient's condition worsened. A full sternotomy was performed, and intrathoracal cardiopulmonary resuscitation started. During examination of the pericardium and the heart, multiple plastic parts from the mesh fixation system were observed transdiaphragmally and were found to have penetrated the diaphragmal part of the right ventricle. In spite of maximum drug, respiratory and surgical therapy, a sufficient heart ejection fraction could not be achieved. Upon interdisciplinary consent, therapy was stopped after 60 min.
authors: Department of Cardiovascular Surgery, University Bonn, Bonn, Germany matthias.endlich@ukb.uni-bonn.de.
authors: Matthias
authors: M
authors: Endlich
authors: Department of Cardiovascular Surgery, University Bonn, Bonn, Germany.
authors: Wolfgang
authors: W
authors: Schiller
authors: Department of Cardiovascular Surgery, University Bonn, Bonn, Germany.
authors: Fritz
authors: F
authors: Mellert
authors: Department of Cardiovascular Surgery, University Bonn, Bonn, Germany.
authors: Chris
authors: C
authors: Probst
mesh_terms: D002305:Cardiac Tamponade / Q000209:etiology; D016887:Cardiopulmonary Resuscitation; D004322:Drainage; D017809:Fatal Outcome; D005548:Foreign-Body Migration / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D006335:Heart Injuries / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D046449:Hernia, Abdominal / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects* / Q000295:instrumentation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010490:Pericardial Effusion / Q000209:etiology; D012086:Reoperation; D056346:Sternotomy; D013526:Surgical Mesh / Q000009:adverse effects*
keywords: Abdominal mesh plastic; Pericardial tamponade; Right heart injury