A46-12 Buffalo Chest Syndrome Following Para-esophageal Hiatal Hernia Repair

Abstract Buffalo chest syndrome is a rare phenomenon which occurs due to communication of the left and right thoracic cavities, resulting in bilateral pneumothorax due to a unilateral insult. Most cases of Buffalo chest syndrome have been described in the setting of cardiothoracic procedures or surgeries, involving either a sternotomy, mediastinoscopy, or thoracotomy. A few cases of Buffalo chest syndrome have occurred after esophagectomy. We describe the case of a 57 yo woman who underwent a para-esophageal hiatal hernia repair via an abdominal approach. She had previously undergone a robotic para-esophageal hiatal hernia repair with modified toupet fundoplication at an outside hospital approximately five years previously, but had developed recurrent symptoms of severe gastro-esophageal reflux. Chest radiograph demonstrated recurrence of the para-esophageal hernia. The repeat surgery was started laparoscopically; however, due to extensive adhesions around the hernia sac, the procedure was converted to open. Intraoperatively, the hernia sac was dissected off the mediastinum. After the stomach was brought into the abdominal cavity and the crus was sutured, an absorbable mesh was secured to the underlying diaphragm. The patient was extubated postoperatively without incident, and her initial recovery in the post-anesthesia care unit was uneventful. Several hours after the procedure, the patient developed respiratory distress, prompting transfer to the intensive care unit, where she was found to have a heart rate of 148, and oxygen saturation of 88% on a non-rebreather mask. Breath sounds were diminished symmetrically. Chest radiograph revealed large bilateral pneumothoraxes. A pneumothorax catheter was placed in the right chest, with large air return. The patient’s condition improved within minutes, with oxygen saturation increasing to 99%. Physical exam revealed improvement of breath sounds on both sides. Subsequent chest radiograph revealed resolution of pneumothorax on both sides. This case represents the first reported instance of Buffalo chest following a diaphragmatic hernia repair. This case is further unusual in that the complication occurred after transabdominal access, rather than thoracotomy. This abstract is funded by: None