ACUTE MYOPERICARDITIS FOLLOWING LAPAROSCOPIC FUNDOPLICATION

A 32-year-old patient experienced a postoperative acute myopericarditi s following laparoscopic surgery for gastrooesophageal reflux (Toupet' s fundoplication). His medical history was unremarkable, apart from co ntrolled arterial hypertension. Peroperative circulation was stable, e xcept a short hypertensive episode at CO2 insufflation, controlled wit h nicardipine. A myopericarditis occurred at the fourth postoperative hour, with apical and inferior hypokinesia at ventriculography, ST-seg ment elevation with unremarkable coronary arteriography. The patient w as discharged at day seven, with a NSAIDs treatment. Echocardiography three and nine months later postoperatively, showed an apical akinesia and persistence of the ST-segment modification, without clinical symp toms. Complications bf laparoscopic fundoplication is either specific to surgery (gastro-oesophageal injury, diaphragmatic injury, mediastin itis, stenosis) or secondary to pneumoperitoneum (pneumothorax, carbon dioxide embolism). In this case, following an apparently uncomplicate d laparoscopy and, except a direct cardiac trauma from a laparoscopic instrument, either coronary artery spasm, or pneumopericardium with CO 2, or delayed gas embolism, or preoperative ''silent'' myopericarditis could be the potential cause of this cardiac complication. (C) 1998 E lsevier, Paris.