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• W2914093820 abstract "Purpose: A 64 yo white male with a history of recurrent paroxysmal atrial fibrillation was admitted to the hospital for elective surgery. He had failed multiple conventional therapies including anti-arrhythmic agents and two previous ablations, but continued to be symptomatic. He was deemed a candidate for minimally invasive pulmonary vein ablation with left atrial appendage ligation, or the mini-MAZE procedure. He underwent the mini-MAZE procedure and tolerated the procedure well. His post-operative course was complicated by weakness, inability to ambulate and recurrent atrial arrhythmias requiring continued anticoagulation. By POD day #5, he began to complain of anorexia, nausea and abdominal discomfort. A preliminary work-up included normal liver and pancreatic enzymes, abdominal ultrasound and CT scan. Despite this, his WBC count continued to rise to approximately 18,000. On POD Day #10, the patient developed four episodes of melena. His anticoagulation was discontinued and GI was consulted. Upon questioning, the patient described dysphagia, epigastric fullness and anorexia. His history included a duodenal ulcer at age 15. Physical exam revealed a well-appearing male with a normal abdominal exam. He was noted to be tachycardic with a heartrate of 104. The patient was placed on an esomeprazole infusion and the decision was made to proceed with an EGD to evaluate upper GI bleeding. EGD revealed what appeared to be a full thickness burn and necrosis at 25–30 cm from the incisors with formation of a pseudodiverticulum. The findings were suspicious for a contained perforation, likely related to the radiofrequency ablation 11 days prior. An emergent CT scan was obtained which revealed a small mediastinal space tract that appeared to connect to an esophageal defect. There was no evidence of free air in the mediastinum to suggest an ongoing leak. The patient was taken emergently to surgery and findings included the above mentioned anterior full-thickness perforation of the esophagus that extended for approximately 2 cms. The patient underwent flexible esophagogastroscopy, placement of esophageal drainage mesogastric tube, exploratory laparotomy, feeding jejunostomy and Stamm gastostomy placement. The esophageal perforation was followed with periodic EGDs and gastrograffin swallow studies. He began tolerating a soft diet and was eventually discharged to a rehabilitation facility 50 days after the initial mini-MAZE procedure. In conclusion, there needs to be a high index of suspicion for esophageal perforation after the mini-MAZE procedure." @default.
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• W2914093820 date "2007-09-01" @default.
• W2914093820 modified "2023-09-25" @default.
• W2914093820 title "A Case of Severe Heartburn" @default.
• W2914093820 doi "https://doi.org/10.14309/00000434-200709002-00010" @default.
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