A 70-year-old woman presented with a giant hiatal hernia with intrathoracic stomach. The patient underwent laparoscopic Nissen fundoplication with hiatal mesh reinforcement using absorbable tacks. On postoperative day 2, the patient developed hypotension, tachycardia, and irregular pulse.\nA CT scan revealed an extrapericardial hematoma in the hernia sac with mild left atrium compromise. Conservative treatment was decided and the patient discharged on postoperative day 15.
A 40-year-old man underwent Collis-Nissen repair of gastroesophageal reflux disease. The night of the operation he became hypotensive and was believed to have cardiac tamponade. Bedside pericardiocentesis was performed with temporary improvement. On returning to the operating room, he coded and died on the operating table. The autopsy findings showed laceration of a coronary vessel.