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 62-year-old woman with gastroesophageal reflux disease and a large hiatal hernia underwent Nissen fundoplication with mesh hiatoplasty using absorbable tacks. On postoperative day 5, the patient developed acute respiratory distress syndrome with hypotension and oliguria. A thoracic CT scan showed a bilateral pleural effusion and a large pericardial effusion that caused the collapse of the right atrium and ventricle. She was taken back to the operating room for urgent surgical pericardial drainage. After that, the postoperative course was uneventful.