Abstract
Background
Cardiopulmonary complications in the postoperative period can lead to significant
morbidity and mortality. Many of the complications in the postoperative period occur
after discharge from the hospital, and up to 25% of patients will require readmission.
In postoperative patients presenting to the emergency department (ED), it is important
to consider that postoperative complications can affect a multitude of organ systems,
including those that are adjacent to where the surgery was performed.
Case Report
We present the case of a 54-year-old woman presenting to the ED with shortness of
breath in the setting of recent Nissen fundoplication revision. Pulmonary angiography
was significant for a large hiatal hernia and negative for pulmonary embolism. She
was discharged and returned to the ED a few days later due to worsening symptoms.
Further diagnostic studies demonstrated an esophageal hematoma causing compression
of the left atrium, leading to acute diastolic heart failure.
Why Should an Emergency Physician Be Aware of This?
It is important to consider alternative etiologies for common complaints in the postoperative
patient presenting to the ED. Early involvement of the operative team in the patient's
care can assist in directing diagnostic approach and management of the postoperative
patient.
Keywords
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References
- Incidence and hospital stay for cardiac and pulmonary complications after abdominal surgery.J Gen Intern Med. 1995; 10: 671-678
- Investigating the “Rule of W,” a mnemonic for teaching on postoperative complications.J Surg Educ. 2015; 72: 430-437
- Incidence, reasons, and risk factors for readmission after surgery for benign distal esophageal disease.Surgery. 2016; 160: 599-606
- Post-operative complications and readmissions following outpatient elective Nissen fundoplication.Surg Endosc. 2020; 34: 2143-2148
- Management and outcome of complications after laparoscopic antireflux operations.Arch Surg. 2001; 136: 399-404
- Management of complications after laparoscopic Nissen's fundoplication: a surgeon's perspective.Ann Surg Innov Res. 2009; 3: 1
- Association between laparoscopic antireflux surgery and recurrence of gastroesophageal reflux.JAMA. 2017; 318: 939-946
- The use of contrast echocardiography in the diagnosis of an unusual cause of congestive heart failure: achalasia.Echocardiography. 2004; 21: 149-152
- Current perspectives in diastolic dysfunction and diastolic heart failure.Heart. 2006; 92: 712-718
- Diagnosing acute heart failure in patients with undifferentiated dyspnea: a lung and cardiac ultrasound (LuCUS) protocol.Acad Emerg Med. 2015; 22: 182-191
- Complications of antireflux surgery.Am J Gastroenterol. 2018; 113: 1137-1147
Article Info
Publication History
Published online: September 12, 2022
Accepted:
September 4,
2022
Received in revised form:
August 11,
2022
Received:
April 16,
2022
Publication stage
In Press Corrected ProofFootnotes
Streaming video: A brief real-time video clip that accompanies this article is available in streaming video at www.journals.elsevierhealth.com/periodicals/jem. Click on Video Clip 1.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
