Extra-cardiac compression and left ventricular inflow obstruction as a complication of a Sengstaken-Blakemore tube

摘要

A 78-year-old man was admitted for a proximal humerus fracture after an accidental fall. On Day 4 after admission, he developed hae-matemesis. Oesophagogastroscopy revealed oesophageal varices. Bleeding could be initially controlled by an endoscopic ligature of the varices, but 1 h later, recurrent haematemesis was seen. A Sengstaken-Blakemore tube was passed down the oesophagus and the gastric balloon was inflated inside the stomach. A traction of 1 kg was applied to the tube, so that the gastric balloon compressed the gas-troesophageal junction. Since the patient had become haemodynamically stable as haematemesis stopped, the oesophageal balloon was not inflated. Five hours after placement of the tube, the patient became hypotensive and tachycardic, although no signs of recurrent haematemesis were seen. Vasopressors were started without restoration of adequate tissue oxy-genation. Serum lactate levels rose to 4.2 mmol/L An urgent transthoracic echocar-diogram revealed an extra-cardiac spherical mass with a diameter of 53 mm, compressing the left atrium (Panel A, Supplementary data online, videos 1-3). Using continuous-wave Doppler, peak flow velocities over the mitral valve were ~1.5 m/s.