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Solving a disaster following coronary bypass operation
  1. Philipp-Alexander Neumann1,
  2. Mike Laukoetter1,
  3. Rudolph Mennigen1,
  4. Linus Kebschull1,
  5. Dominik Bettenworth2,
  6. Frank Lenze2,
  7. Hansjoerg Ullerich2,
  8. Norbert Senninger1,
  9. Thorsten Vowinkel1
  1. 1 Department of General and Visceral Surgery, University of Muenster, Muenster, Germany
  2. 2 Department of Medicine B, University of Muenster, Muenster, Germany
  1. Correspondence to Dr Philipp-Alexander Neumann, Department of General and Visceral Surgery, University of Muenster, Albert-Schweitzer Campus, W1, Muenster 48149, Germany; paneumann{at}

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Clinical presentation

A 72-year-old male patient underwent coronary bypass surgery and presented with atrial fibrillation upon completion of the operation. Intraoperative transesophageal echocardiography (TEE) was performed, followed by successful electric cardioversion. The initially stable patient developed a systemic inflammatory response syndrome on day 7 after the operation. The septic course progressed over the next days, necessitating reintubation and placement of a nasogastric feeding tube. Since the patient did not stabilise despite escalation of antibiotic therapy, he was referred to our department of general surgery. A CT scan of thorax and abdomen revealed the images shown in figure 1.

Figure 1

CT scan of the upper abdomen showing free air …

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