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.
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.