Department of Medicine, Columbia University Medical Center, New York, USA.
Catheter Cardiovasc Interv. 2011 Nov 1;78(5):819-21. doi: 10.1002/ccd.23178. Epub 2011 Oct 11.
We report the case of a 61-year old female with history of gastroesophageal reflux disease and hiatal hernia who developed hemopericardium and tamponade one day after laparoscopic hiatal hernia repair and Toupe fundoplication. The patient underwent emergent pericardiocentesis and subsequent surgical pericardial window. During surgery, a tack that had been used to secure mesh to the inferior aspect of the diaphragm was found to have penetrated the pericardium near the right ventricle. The offending foreign body was trimmed and reduced into the abdomen, and the patient recovered without further complication. A review of the literature reveals that, although rare, tamponade following diaphragmatic hernia repair and fundoplication surgery often results in fatal outcome. Tamponade must be considered in any patient who develops signs of hemodynamic instability following diaphragmatic hernia repair or fundoplication surgery, as rapid diagnosis and definitive intervention can decrease fatality from such an injury.
我们报告了一例 61 岁女性病例，该患者有胃食管反流病和食管裂孔疝病史，在腹腔镜食管裂孔疝修补和 Toupe 胃底折叠术后一天出现血胸和心脏压塞。患者接受了紧急心包穿刺术和随后的外科心包开窗术。手术中发现，用于将网片固定在膈肌下的一个缝合钉穿透了右心室附近的心包。将有问题的异物修剪并缩小到腹部，患者没有进一步并发症而康复。文献复习表明，尽管罕见，但膈疝修补和胃底折叠术后发生心脏压塞通常会导致致命后果。任何在膈疝修补或胃底折叠术后出现血流动力学不稳定迹象的患者都应考虑心脏压塞，因为快速诊断和明确干预可以降低此类损伤的死亡率。
