Document Type

Article

Publication Title

JEM Reports

Abstract

Background: Laparoscopic fundoplication is commonly performed for refractory gastroesophageal reflux disease and symptomatic hiatal hernia, but rare postoperative complications such as esophageal perforation may result in significant morbidity and mortality if not promptly recognized.

Case report: We present a case of esophageal perforation complicated by massive hydropneumothorax in a woman who presented to the emergency department with progressive chest pain, abdominal pain, and respiratory distress two weeks after hiatal hernia repair with Nissen fundoplication. Emergent tube thoracostomy performed in the emergency department drained a large volume of purulent fluid and resulted in immediate respiratory improvement. Computed tomography with oral contrast subsequently demonstrated distal esophageal perforation with associated mediastinitis. The patient underwent operative management by the cardiothoracic surgery team and recovered well, ultimately being discharged home in stable condition two weeks later.

Why should an emergency physician be aware of this?: Patients frequently present to the emergency department with postoperative complications. Emergency physicians must be able to promptly recognize and stabilize an esophageal perforation, as delayed diagnosis and treatment are associated with significant morbidity and mortality.

DOI

10.1016/j.jemrpt.2026.100268

Publication Date

12-2026

Keywords

Esophageal perforation, Post-op complication, Hydropneumothorax, Niessen fundoplication

ISSN

2773-2320

Download

Share

COinS