A 57-year-old woman presented with right, medial, and left congenital diaphragmatic hernia defect. The hernia defect was closed laparoscopically by a running suture and then a mesh placed as an onlay fixed with helical hernia tacks. The patient developed cardiac tamponade on the second day due to tack-induced bleeding of an epicardial artery of the inferior surface of the heart, which required emergency pericardial drainage. The outcome was good, and discharge home was allowed after 1 month.
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.