Large mediastinal haematoma after paraoesophageal hernia repair

What is it about?

Mediastinal hematoma is a rare complication of laparoscopic paraesophageal hernia repair with few documented cases in the current literature. Presentation of this unique clinical problem can range from extrinsic esophageal obstruction to life threatening cardiac tamponade and; therefore, warrants further discussion of at risk populations, etiology, diagnosis and successful management strategies. We present the case of a 71-year-old woman who underwent laparoscopic paraesophageal hernia repair with Nissen fundoplication complicated by severe dysphagia on post-operative day twelve. Further evaluation with esophagram and CT imaging revealed a large mediastinal hematoma with near obstruction of the distal esophagus. This was managed successfully with laparoscopic transhiatal washout and drainage.

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