An 82-year-old man presented with an 8-cm mixed hiatal hernia with grade IV esophagitis. Surgical treatment consisted of laparoscopically mesh-augmented hiatoplasty with anterior fundophrenicopexy. Because of accidental rupture of the right crus of the diaphragm, a 15 × 15 cm prolene mesh was necessary to reconstruct the hiatus. The mesh was fixed by 16 helical tacks. During the first 24 postoperative hours, deteriorating oxygen saturation with increasing dyspnea was most notable. After 48 h, the patient experienced severe retrosternal pressure with simultaneous tachyarrhythmia and consecutive circulatory failure. The patient died despite resuscitation attempts. The autopsy revealed cardiac tamponade originating from an epicardial vascular erosion caused by one of the helical tacks.
A 40-year-old man underwent Collis-Nissen repair of gastroesophageal reflux disease. The night of the operation he became hypotensive and was believed to have cardiac tamponade. Bedside pericardiocentesis was performed with temporary improvement. On returning to the operating room, he coded and died on the operating table. The autopsy findings showed laceration of a coronary vessel.