The way to a man’s heart is through the stomach

Excerpt

A known patient with left lobe liver abscess who initially refused the aspiration had sudden respiratory distress. On examination, though his vital parameters were stable, the neck veins were prominent. Chest percussion revealed widening of the pre-cardiac dull area. A loud metallic splashing sound synchronous with the heart sounds and the pericardial knock was heard with an absence of third heart sound. Chest X-ray revealed hydropneumopericardium. The patient was immediately resuscitated with pericardial aspiration. Gastroscopy (Fig. 1a) revealed pulsating heart through the anterior wall of the stomach communicating with the pericardial cavity through the central portion of the diaphragm. Intraoperatively, there was a huge abscess cavity causing almost complete destruction of left lobe of liver (Fig. 1b). Abscess cavity had slough with pus and was communicating with the pericardium on one side and with stomach on another side. Stomach wall was separated from pericardial opening and was repaired in two layers. The gap in the diaphragm was closed using prolene sutures after putting a drainage tube in the pericardial cavity and another one in the peritoneal cavity. The patient did well in postoperative period.

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