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Esophagus

, Volume 4, Issue 2, pp 79–82 | Cite as

Cardiac tamponade as a postoperative complication of spontaneous esophageal rupture

  • Koji Tanaka
  • Hitoshi Tonouchi
  • Naomi Konishi
  • Yukinari Ohmori
  • Yasuhiko Mohri
  • Chikao Miki
  • Masato KusunokiEmail author
CASE REPORT

Abstract

We report a case of Boerhaave's syndrome developing cardiac tamponade caused by an esophageal leak after primary repair, despite a normal postoperative contrast study. A 65-year-old man underwent emergency surgery for spontaneous esophageal rupture leading to septic shock. He recovered from the septic condition within 2 weeks. Oral intake was started on the 17th postoperative day with no evidence of esophageal leak. Hypotension, tachycardia, and low urine output gradually developed, although he was not in a septic condition. Chest computed tomography demonstrated a large pericardial effusion with a floating heart, consistent with cardiac tamponade. On the 26th postoperative day, pericardiocentesis resulted in symptomatic and hemodynamic improvement. Because of an increase in leukocyte count and C-reactive protein after oral intake, esophageal leak was suspected as the possible cause of effusive pericarditis leading to cardiac tamponade. Water-soluble contrast examination revealed a small esophageal leak at the repaired site on the 27th postoperative day. Cardiac tamponade is a rare complication of Boerhaave's syndrome. Cardiac tamponade caused by esophageal leak may occur after primary repair of the tear in a patient with Boerhaave's syndrome and should be considered as a cause of hypotension, tachycardia, and low urine output during the postoperative course.

Key words

Boerhaave's syndrome Cardiac tamponade Esophageal leak 

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References

  1. 1.
    Okten, I, Cangir, AK, Ozdemir, N, Kavukcu, S, Akay, H, Yavuzer, S 2001Management of esophageal perforationSurg Today31369PubMedCrossRefGoogle Scholar
  2. 2.
    Ojima, H, Kuwano, H, Sasaki, S, Fujisawa, T, Ishibashi, Y 2001Successful late management of spontaneous esophageal rupture using T-tube mediastinoabdominal drainageAm J Surg1821926PubMedCrossRefGoogle Scholar
  3. 3.
    Seki, H, Ueda, T, Shibata, Y 2001Spontaneous esophageal perforation related to a duodenal ulcer with pyloric stenosis: report of a caseSurg Today3110826PubMedCrossRefGoogle Scholar
  4. 4.
    Sung, SW, Park, JJ, Kim, YT, Kim, JH 2002Surgery in thoracic esophageal perforation: primary repair is feasibleDis Esophagus152049PubMedCrossRefGoogle Scholar
  5. 5.
    Wang, N, Razzouk, AJ, Safavi, A, Gan, K, Van Arsdell, GS, Burton, PM,  et al. 1996Delayed primary repair of intrathoracic esophageal perforation: is it safe?J Thorac Cardiovasc Surg11111421PubMedCrossRefGoogle Scholar
  6. 6.
    Hill, AG, Tiu, AT, Martin, IG 2003Boerhaave's syndrome: 10 years experience and review of the literatureANZ J Surg12100810CrossRefGoogle Scholar
  7. 7.
    Karmy-Jones, R, Yen, T, Cornejo, C 2002Pericarditis after trauma resulting in delayed cardiac tamponadeAnn Thorac Surg7423941PubMedCrossRefGoogle Scholar
  8. 8.
    Dunsire, MF, Field, J, Valentine, S 2001Delayed diagnosis of cardiac tamponade following isolated blunt abdominal traumaBr J Anaesth8730912PubMedCrossRefGoogle Scholar
  9. 9.
    Fejka, M, Dixon, SR, Safian, RD, O'Neill, WW, Grines, CL, Finta, B,  et al. 2002Diagnosis, management, and clinical outcome of cardiac tamponade complicating percutaneous coronary interventionAm J Cardiol9011836PubMedCrossRefGoogle Scholar
  10. 10.
    Hankins, JR, McLaughlin, JS 1977Pericarditis with effusion complicating esophageal perforationJ Thorac Cardiovasc Surg7322530PubMedGoogle Scholar
  11. 11.
    Sharland, MG, McCaughan, BC 1993Perforation of the esophagus by a fish bone leading to cardiac tamponadeAnn Thorac Surg5696971PubMedCrossRefGoogle Scholar
  12. 12.
    Wright, CD, Mathisen, DJ, Wain, JC, Moncure, AC, Hilgenberg, AD, Grillo, HC 1995Reinforced primary repair of thoracic esophageal perforationAnn Thorac Surg602458PubMedCrossRefGoogle Scholar
  13. 13.
    Whooley, BP, Law, S, Alexandrou, A, Murthy, SC, Wong, J 2001Critical appraisal of the significance of intrathoracic anastomotic leakage after esophagectomy for cancerAm J Surg181198203PubMedCrossRefGoogle Scholar
  14. 14.
    Griffin, SM, Lamb, PJ, Dresner, SM, Richardson, DL, Hayes, N 2001Diagnosis and management of a mediastinal leak following radical oesophagectomyBr J Surg88134651PubMedCrossRefGoogle Scholar
  15. 15.
    Kim, KW, Choi, BI, Han, JK, Kim, TK, Kim, AY, Lee, HJ,  et al. 2002Postoperative anatomic and pathologic findings at CT following gastrectomyRadiographics2232336PubMedCrossRefGoogle Scholar

Copyright information

© Japan Esophageal Society and Springer-Verlag 2007

Authors and Affiliations

  • Koji Tanaka
    • 1
  • Hitoshi Tonouchi
    • 2
  • Naomi Konishi
    • 1
  • Yukinari Ohmori
    • 1
  • Yasuhiko Mohri
    • 1
  • Chikao Miki
    • 1
  • Masato Kusunoki
    • 1
    • 2
    Email author
  1. 1.Department of Gastrointestinal and Pediatric SurgeryMie University Graduate School of MedicineMieJapan
  2. 2.Department of Innovative SurgeryMie University Graduate School of MedicineMieJapan

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