Massive Haemorrhage In Patient After Repair Of Post Esophagectomy Diaphragmatic Hernia And A Loading Dose Of Clopidogrel.

Abstract

Postoperative 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.

• Authors: Huma Saleem, Sara Haider Malik, Syed Raza Mehdi
• Journal: Journal of Ayub Medical College, Abbottabad : JAMC (J Ayub Med Coll Abbottabad) 2018 Oct-Dec Vol. 30 Issue 4 Pg. 611-613 ISSN: 1819-2718 [Electronic] Pakistan
• PMID: 30632349 (Publication Type: Case Reports, Journal Article)

Chemical References

• Platelet Aggregation Inhibitors
• Clopidogrel

Topics

• Acute Coronary Syndrome (diagnosis, drug therapy)
• Adult
• Clopidogrel (adverse effects)
• Diagnostic Errors
• Esophagectomy (adverse effects)
• Hemorrhage (chemically induced)
• Hernia, Diaphragmatic (diagnostic imaging, etiology)
• Humans
• Male
• Platelet Aggregation Inhibitors (adverse effects)
• Postoperative Complications
• Tomography, X-Ray Computed