Gastric injury following transesophageal echocardiography during cardiac surgery: a case series

Abstract

　Transesophageal echocardiography (TEE) may be used during cardiovascular surgery to provide direct visualization of cardiac structures. It is considered both a diagnostic and monitoring tool to improve surgical safety and clinical outcomes. While complications, such as gastric injury, after manipulating the TEE probe are rare, such complications can be severe and fatal. In this case series, three cases of gastric injury after TEE utilization for cardiac surgeries are reported. Case 1 was a patient with bleeding from a gastric ulcer and represented days after postoperative anticoagulant therapy, which was complicated with undiagnosed gastric antral vascular ectasia (GAVE). Case 2 was a patient with esophageal injury which was detected when the mouth filled with blood immediately after insertion of the TEE probe. Case 3 was a patient with a gastric laceration following TEE without symptoms which progressed to severe gastric damage because of anaphylactic shock at postoperative day 12. Even if successful TEE manipulation was performed during operation, every clinician must consider that undiagnosed gastric injury may exist in all cases and be prepared to respond appropriately to mitigate risk.