MASSIVE HAEMORRHAGE IN PATIENT AFTER REPAIR OF POST ESOPHAGECTOMY DIAPHRAGMATIC HERNIA AND A LOADING DOSE OF CLOPIDOGREL
AbstractPostoperative diaphragmatic hernia (PDH) is an increasingly reported complication of esophageal cancer surgery. It occurs more frequently with minimally invasive techniques and very little is known about its pathogenesis. Currently, no consensus exists concerning preventive measures and its management. A 36 years old male underwent minimally invasive esophagectomy and presented with chest pain and dyspnoea in the emergency department 8 months after the procedure. He was started on acute coronary syndrome treatment protocol but was later diagnosed on CT scan to have diaphragmatic hernia through a defect in the oesophageal hiatus. As he was already loaded with dual anti platelet therapy it led to qualitative defect of the platelet which resulted in bleeding post procedure and the patient needed resuscitation with blood products. Dual anti‐platelet therapy is an integral component of early management strategy in acute coronary syndrome. Chest X-ray was not helpful, but abdominal or chest computed tomography was useful for accurate diagnosis.Keywords: massive haemorrhage; esophagectomy; diaphragmatic hernia; dual anti platelet therapy
Kim D, Kim SW, Hong JM. Diaphragmatic Hernia after Transhiatal Esophagectomy for Esophageal Cancer. Korean J Thorac Cardiovasc Surg 2016;49(4):306–8.
Ng FH, Wong SY, Chang CM, Chen WH, King C, Lanas AI, et al. High incidence of clopidogrel‐associated gastrointestinal bleeding in patients with previous peptic ulcer disease. Ailment Pharmacol Ther 2003;18(4):443–9.
Price TN, Allen MS, Nichols FC 3rd, Cassivei SD, Wigle DA, Shen KR, et al. Hiatal hernia after esophagectomy: Analysis of 2,182 esophagectomies from a single institution. Ann Thorac Surg 2011;92(6):2041–5.
Argenti F, Luhmann A, Dolan R, Wilson M, Podda M, Patil P, et al. Diaphragmatic hernia following oesophagectomy for oesophageal cancer – Are we too radical? Ann Med Surg (Lond) 2016;6:30–5.
Lind SE. The bleeding time does not predict surgical bleeding. Blood 1991;77(12):2547–52.
Vaughn C, Mychaskiw G 2nd, Sewell P. Massive Hemorrhage During Radiofrequency Ablation of a Pulmonary Neoplasm. Anesth Analg 2002;94(5):1149–51.