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.
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.