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Editor's quiz: GI snapshot
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}uni-muenster.de

http://dx.doi.org/10.1136/gutjnl-2015-311233

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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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    Footnotes

    • Contributors All authors have contributed to the conception or design of the work, or the acquisition, analysis or interpretation of data; drafted the work or revising it critically for important intellectual content; made final approval of the version published; agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

    • Competing interests ML is a member of the expert panel of negative pressure wound therapy of the Paul Hartmann (AG) holding company. He received fees for invited speeches on endoscopic vacuum therapy.

    • Patient consent Obtained.

    • Ethics approval Ethical Committee of the University of Muenster, Germany.

    • Provenance and peer review Not commissioned; externally peer reviewed.