An 84-year-old woman suffered from a type IV diaphragmatic hernia with a tortuous intrathoracic stomach and grade II esophagitis. The stomach was reduced into the abdominal cavity and the hernia sac resected. A coated polyester mesh was attached to the crura with 5-mm titanium helical tacks. After an uneventful recovery, the patient suddenly developed cardiogenic shock on postoperative day 14. A left thoracotomy was subsequently performed. There was active bleeding of the epicardium from a number of pointed lesions, just opposite the tackers which had penetrated the pericardium. The offending tacks were removed and the defects in the epicardium sutured. The patient was discharged 18 days after thoracotomy.
A 66-year-old female patient underwent surgery because of a large paraesophageal hiatal hernia. Just prior to the fundal wrap of the Nissen fundoplication, the patient suddenly became tachycardic and profoundly hypotensive. Emergency sternotomy revealed hemopericardium and a 2-cm laceration of the diaphragmatic surface of the right ventricle, which was controlled by placement of several sutures. The authors believed that the injury to the heart was secondary to a perforating needle on the contracting ventricle. The patient could be discharged from hospital on postoperative day 21.