Polymicrobial bacterial pericarditis and cardiac tamponade caused by pericardial penetration of an adjustable gastric band

Abstract

We describe a case of polymicrobial bacterial pericarditis with Klebsiella pneumoniae and Proteus mirabilis, caused by pericardial penetration of the tip of the catheter of a laparoscopic adjustable gastric band (LAGB). The patient developed a cardiac tamponade, and subsequently emergency pericardiocentesis was performed. Analysis of earlier CT scans showed that the tip of the catheter had migrated through the liver and through the diaphragm into the pericardium, and was in contact with the myocardium. After stabilisation he was operated to remove the LAGB. In this case report, we describe the chain of events that led to the polymicrobial pericarditis-a complication of LAGB placement that to our knowledge has thus far never been reported. We furthermore present a detailed literature review of all published cases of polymicrobial pericarditis and its causes.

Keywords: emergency medicine; gastroenterology; gastrointestinal surgery; interventional cardiology.

Figure 1

Reconstructions of CT imaging. The LAGB catheter was located just caudally of the left lobe of the liver in 2011 (A–C) and had migrated into the left lobe (D–F) in 2012. In 2014 the tip of the catheter had travelled through the diaphragm into the pericardium (G–I).LAGB, laparoscopic adjustable gastric band.