Zusammenfassung
Bei dem geschilderten Fall handelt es sich um die Erstbeschreibung einer schweren Komplikation bei der Nuss-Operation. Neben den konventionellen OP-Verfahren zur Behandlung der Trichterbrust nach Rehbein und Ravitch, hat in den letzten Jahren die minimalinvasive Methode nach Nuss Eingang in die Therapie gefunden. Es wird über den Fall eines 21-jährigen Mannes, der 4 Monate vorher der Nuss-Operation unterzogen wurde und 2 Stahlbügel implantiert bekam, berichtet. Bei der Erstoperation war es zu einer unbemerkten Läsion des Centrum tendineum des linken Zwerchfells gekommen. Der Patient wurde in der Akutsituation einer inkarzerierten Zwerchfellhernie operiert. Neben dem kompletten und torquierten Magen befanden sich das Colon transversum und die Milz im Thorax. Bei Narkoseeinleitung kam es zum Herzkreislaufstillstand. Nach erfolgreicher Reanimation wurde die Operation thorako-abdominal durchgeführt und das Zwerchfell von thorakal aus primär verschlossen. Auch andere Autoren berichteten schon über lebensbedrohliche Komplikationen wie z. B. eine Herzperforation. Eine sorgfältige Evaluation der Methode nach Nuss mit Festlegung von klaren Indikationen im Hinblick auf Alter der Patienten, Thoraxdeformierung und Bindegewebserkrankungen muss erfolgen, um diese Methode nicht in Misskredit zu bringen.
Abstract
This report is the first description of an additional major complication seen with the Nuss repair. In addition to the conventional Rehbein and Ravitch operations for funnel chest, the minimally invasive procedure developed by Nuss has recently been added to the therapeutic options. The present report describes the case of a 21-year-old man who underwent a Nuss repair with implantation of 2 pectus bars 4 months previously. During the primary operation the central tendon of the left diaphragm was unnoticed injured. We performed an emergency operation on the patient to repair an incarcerated diaphragmatic hernia. The thorax was found to contain not only the entire, twisted stomach, but also the transverse colon and the spleen. During induction of anaesthesia the patient suffered a cardiovascular collapse. After successful resuscitation, thoraco-abdominal surgery was performed and the diaphragm closed from the thoracic side. Other authors have also reported major life-threatening complications of the Nuss-procedure, such as perforation of the heart. A careful evaluation of this procedure and the establishment of clear indications taking the age of the patient, the thoracic deformity and connective tissue disease into account, are mandatory to avoid discredit of this method.
Schlüsselwörter
Pectus excavatum - Nuss-Technik - minimalinvasive Chirurgie - Komplikationen - Thorakoskopie - Thoraxdeformitäten
Key words
Pectus excavatum - Nuss-procedure - minimally invasive surgery - complications - thoracoscopy - deformities of the chest
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