Right Ventricular Extrinsic Compression Tamponade Caused by Dilation/Necrosis of a Coloplasty Performed for Esophageal Squamous Cell Carcinoma.

Abstract

In the context of dysphagia, an infiltrating squamous cell carcinoma of the esophagus was diagnosed in a 43-year-old woman with a history of two liver and one kidney transplants as a result of Alagille syndrome. An esophagectomy with retrosternal left coloplasty (esocolic, gastrocolic, and colocolic anastomoses) was performed. On postoperative day 2, her hemodynamic status deteriorated resulting in significant increases in norepinephrine doses (from 0.33 to 2 micg/kg/min). Transthoracic echocardiography was difficult to perform because the patient had limited imaging windows. Transesophageal echocardiography was contraindicated due to the nature of her surgery. An emergency thoraco-abdominal CT scan showed that the coloplasty was dilated, ischemic, and compressing the right ventricle anteriorly. Emergency surgery revealed mediastinitis with necrosis of the coloplasty. Surgical decompression of the coloplasty led to rapid improvement in hemodynamics, requiring only reduced doses of norepinephrine.