title: Esophagopericardial fistula, septic shock and intracranial hemorrhage with hydrocephalus after lung transplantation.
abstract: A 57-year old woman underwent lung transplantation for non-specific interstitial pneumonia. Primary graft dysfunction was diagnosed requiring continued use of extracorporeal membrane oxygenation (ECMO). Within three days she developed recurring hemothoraces requiring two surgical evacuations. After ECMO removal a series of complications occurred within four months: femoral thrombosis, persisting tachycardic atrial fibrillation, pneumopericardium with an esophagopericardial fistula and purulent pericarditis, septic shock, multiorgan failure and intracerebral hemorrhage with ventricular involvement requiring external ventricular drainage. Interdisciplinary management coordinated by the intensive care specialist, transplant surgeon and pulmonologist with various interventions by the respective specialists followed by intensive physical rehabilitation allowed for discharge home on day 235 post transplant. Subsequently quality of life was considered good by the patient and family.
authors.affiliation: University Hospital Zurich, Pulmonology, Zurich, Switzerland. Electronic address: Mace.schuurmans@usz.ch.
authors.forename: M M
authors.initials: MM
authors.lastname: Schuurmans
authors.affiliation: University Hospital Zurich, Pulmonology, Zurich, Switzerland.
authors.forename: C
authors.initials: C
authors.lastname: Benden
authors.affiliation: University Hospital Zurich, Anaesthesiology, Zurich, Switzerland.
authors.forename: C
authors.initials: C
authors.lastname: Moehrlen
authors.affiliation: University Hospital Zurich, Gastroenterology, Zurich, Switzerland.
authors.forename: C
authors.initials: C
authors.lastname: Gubler
authors.affiliation: University Hospital Zurich, Cardiac Surgery, Zurich, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Wilhelm
authors.affiliation: University Hospital Zurich; Thoracic Surgery, Zurich, Switzerland.
authors.forename: W
authors.initials: W
authors.lastname: Weder
authors.affiliation: University Hospital Zurich; Thoracic Surgery, Zurich, Switzerland.
authors.forename: I
authors.initials: I
authors.lastname: Inci
mesh_terms: D004937:Esophageal Fistula / Q000150:complications*; D005260:Female; D005402:Fistula / Q000150:complications*; D006331:Heart Diseases / Q000150:complications*; D006801:Humans; D006849:Hydrocephalus / Q000150:complications*; D020300:Intracranial Hemorrhages / Q000150:complications*; D016040:Lung Transplantation; D008875:Middle Aged; D010496:Pericardium; D012772:Shock, Septic / Q000150:complications*
keywords: Complications; Esophagopericardial fistula; Intracranial hemorrhage; Lung transplantation; Treatment