Aldama LKE, Sánchez CCA, Salinas OCL, Sanabria TR

Language: Spanish
References: 11
Page: 123-126
PDF size: 202.80 Kb.

ABSTRACT

Introduction: Laparoscopic fundoplication has become the surgical treatment of choice for gastroesophageal reflux disease due to minimal complications, one of which is esophageal or gastric perforation, this last one has the lowest incidence, but is the one with the worst prognosis. Most gastric perforations are detected and treated intraoperatively and those detected in the postoperative period require reoperation and present a high morbidity and mortality due in some cases to the presence of acute mediastinitis, of which the reports in the literature are limited. In addition, there are few reported cases of perforation with simultaneous herniation. Method: A clinical case of a patient who underwent intrathoracic gastric perforation is presented as the complication of a laparoscopic fundoplication, presenting acute mediastinitis. It describes its management and evolution as well as a review of the subject. This case was managed with surgical reoperation, drainage and placement of pleural and pericardial drains. Results: The patient died despite adequate treatment. Conclusions: Postoperative gastric perforation by laparoscopic fundoplication may be complicated by acute mediastinitis, the most lethal chest infection. It is a rare complication, with a difficult diagnosis due to its non-specific presentation and its late diagnosis increases its mortality.

REFERENCES

1. Singhal T, Balakrishnan S, Hussain A, Grandy-Smith S, Paix A, El-Hasani S. Management of complications after laparoscopic Nissen’s fundoplication: a surgeon’s perspective. Ann Surg Innov Res. 2009; 3: 1.

2. Richter JE. Gastroesophageal reflux disease treatment: side effects and complications of fundoplication. Clin Gastroenterol Hepatol. 2013; 11: 465-471; quiz e39.

3. Zhang LP, Chang R, Matthews BD, Awad M, Meyers B, Eagon JC, et al. Incidence, mechanisms, and outcomes of esophageal and gastric perforation during laparoscopic foregut surgery: a retrospective review of 1,223 foregut cases. Surg Endosc. 2014; 28: 85-90.

4. Johansson B, Glise H, Hallerbäck B. Thoracic herniation and intrathoracic gastric perforation after laparoscopic fundoplication. Surg Endosc. 1995; 9: 917-918.

5. Lococo F, Cesario A, Meacci E, Granone P. Intrathoracic gastric perforation: a late complication of an unknown postpartum recurrent hiatal hernia. Interact Cardiovasc Thorac Surg. 2012; 15: 317-318.

6. Vogelaar FJ, Adhin SK, Schuttevaer HM. Delayed intrathoracic gastric perforation after obesity surgery: a severe complication. Obes Surg. 2008; 18: 745-746.

7. Pierce TB, Razzuk MA, Razzuk LM, Luterman DL, Sutker WL. Acute mediastinitis. Proc (Bayl Univ Med Cent). 2000; 13: 31-33.

8. Jabłoński S, Brocki M, Kordiak J, Misiak P, Terlecki A, Kozakiewicz M. Acute mediastinitis: evaluation of clinical risk factors for death in surgically treated patients. ANZ J Surg. 2013; 83: 657-663.

9. Macrí P, Jiménez MF, Novoa N, Varela G. Análisis descriptivo de una serie de casos diagnosticados de mediastinitis aguda. Arch Bronconeumol. 2003; 39: 428-430.

10. Carrillo-Esper R, Elizondo-Argueta S, Sánchez-Zúñiga MJ, López-Martínez A, Carrillo-Córdova JR. Perforación esofágica y mediastinitis secundarias a funduplicatura laparoscópica tipo Nissen. Reporte de un caso y revisión de la literatura. Rev Fac Med UNAM. 2008; 51: 15-17.

11. Seoane-Vigo M, Galán-Raposo L, Ares-Farpón F, Concejo-Cútoli P, González-Crespo L. Mediastinitis secundaria a perforación de una hernia de hiato por deslizamiento. Rev Acircal. 2014; 1: 64-69.