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 61-year-old female with a history of gastroesophageal reflux disease and hiatal hernia developed hemopericardium and tamponade one day after laparoscopic hiatal hernia repair and Toupet fundoplication. The patient underwent emergency pericardiocentesis and subsequent surgical pericardial window. During surgery, a tack that had been used to secure the mesh to the inferior aspect of the diaphragm was found to have penetrated the pericardium near the right ventricle. The patient recovered without further complications.