Hasegawa Makoto, Kikuchi Tomohiro, Yago Hiroki, Mitsui Dai, Matsuishi Akira, Tsumuraya Hideaki, Kaneta Akinao, Matsuida Hajime, Nirei Azuma, Hanayama Hiroyuki, Saze Zenichiro, Takase Shinya, Kono Koji
Department of Gastrointestinal Tract Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan.
Department of Cardiovascular Surgery, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima 960-1295, Japan.
J Surg Case Rep. 2024 Aug 28;2024(8):rjae555. doi: 10.1093/jscr/rjae555. eCollection 2024 Aug.
Cardiac tamponade is a rare postoperative complication of esophagectomy, with no previous reports of association with coronary artery aneurysm rupture. We present a case of cardiac tamponade caused by coronary aneurysm rupture following esophageal cancer surgery. A 68-year-old man with no history of heart disease underwent robotic subtotal esophagectomy for esophageal squamous cell carcinoma. He experienced intermittent chest pain on postoperative day (POD) 17. Echocardiography revealed increasing pericardial fluid, and pericardiocentesis on POD 34 revealed bloody pericardial fluid. Contrast-enhanced computed tomography and coronary angiography revealed a ruptured coronary aneurysm causing cardiac tamponade. Emergency surgery with a median sternotomy achieved hemostasis, and the patient recovered successfully. Cardiac tamponade after esophageal surgery, particularly from coronary aneurysm rupture, is rare. Prompt diagnosis and treatment are crucial for patient survival. Despite its risks, median sternotomy was effective in achieving rapid hemostasis and patient recovery in this case.
心脏压塞是食管癌切除术后一种罕见的并发症，此前尚无与冠状动脉瘤破裂相关的报道。我们报告一例食管癌手术后因冠状动脉瘤破裂导致心脏压塞的病例。一名无心脏病史的68岁男性因食管鳞状细胞癌接受了机器人辅助食管次全切除术。术后第17天他出现间歇性胸痛。超声心动图显示心包积液增多，术后第34天行心包穿刺术抽出血性心包积液。增强计算机断层扫描和冠状动脉造影显示冠状动脉瘤破裂导致心脏压塞。经正中胸骨切开术进行的急诊手术实现了止血，患者成功康复。食管手术后的心脏压塞，尤其是由冠状动脉瘤破裂引起的，很罕见。及时诊断和治疗对患者生存至关重要。尽管有风险，但在本病例中，正中胸骨切开术有效地实现了快速止血和患者康复。
