Tension colothorax causing cardiac tamponade: A life-threatening complication following transhiatal oesophagectomy
A 65 year old male diabetic patient underwent transhiatal oesophagectomy and gastric resection for adenocarcinoma of the gastro-oesophageal junction. On the 10th postoperative day, he developed progressive breathlessness which became severe by the next day. Air entry was significantly reduced on the left hemithorax. Chest X-ray as in revealed large bowel loops in the left hemithorax leading to a diagnosis of diaphragmatic hernia. The patient was rushed for an emergency thoracolaparotomy.\nClinical examination revealed that the patient had severe respiratory distress with inability to lie down, nasal flaring, active accessory muscles, sweating and dilated neck veins. The respiratory rate was 40/min. The pulse was thready with a rate of 180/min and blood pressure of 90/60 mmHg. He maintained oxygen saturation of 85-90% with supplemental oxygen of 6 l/min.\nThe patient was preoxygenated and induced in sitting position. Fluid resuscitation was initiated. Airway was secured by rapid sequence induction technique. Haemodynamic instability continued despite fluid resuscitation. Thus, noradrenaline infusion was initiated at 0.05-0.1 μg/kg/min. The airway pressures went up to 42 cm of water.\nAn immediate and dramatic improvement in the haemodynamic parameters and resolution of high airway pressures was observed following reduction of the herniated colon. Noradrenaline infusion could be immediately weaned off.\nPostoperatively, the patient was transferred to the intensive care unit for ventilatory support in view of severe mixed acidosis. He was weaned off and extubated the next day. Eventually, the patient succumbed to septic shock following anastomotic leak.