Girl presenting with oesophageal spasm pain after fundoplication

Introduction: A previously healthy 19-year-old woman, who had symptoms of gastric-oesophagela reflux disease for over one year, was transferred to our specialist hospital three weeks post fundoplication operation at a local hospital. She had several episodes with severe retrosternal pain lasting minutes to hours which was stabbing in character. She persistently experienced what was thought to be episodes of oesophageal spasm associated with food intake or movement. She required gradually escalating doses of opioids, both transdermal, intramuscular and intravenous. She was started on a regime of transdermal opioids in addition to iv opioids for the acute pain episodes. This was later supplemented with a PCA pump. Despite the increase in pain and in CRP, the patient was continued on an opioid reduction regime initiated by the surgeons six weeks post surgery. Two months post fundoplication she developed respiratory failure. Discussion: The patient had a prolonged and painful postoperative period after an elective fundoplication. Her retrosternal pain had lasted over a year prior to surgery, but postoperatively a spasmic pain escalated substantially leaving her hospitalised. The symptoms where initially thought to be due to oesophageal spasm, but gastroscopy was normal and manometry showed normal contraction pressures in the oesophagus. It was discovered that she had right sided pleuritis that had developed into an empyema. She was intubated, sedated and initially treated with two chest drains before undergoing a right sided thoracotomy that removed the remaining pleural fluid areas and the postinfectious tissue. The exact mechanism of this complication is not known. Conclusion: Oesophageal spasms after fundoplication is a known complication in about 1 in 1000 patients and is associated with intense spasmic retrosternal pain. However, empyema also needs to be considered where postoperative pain persists. It is an extremely rare and painful complication.

Object Details

• Location: Deutsche Nationalbibliothek Frankfurt am Main
• Extent: Online-Ressource
• Language: Englisch

References and Relationships

• Bibliographic citation: Girl presenting with oesophageal spasm pain after fundoplication ; volume:1 ; number:3 ; year:2010 ; pages:172-172 ; extent:1 ; Scandinavian journal of pain ; 1, Heft 3 (2010), 172-172 (gesamt 1)

Contributors, Places and Time

• Creator: Gawecka, Ewa ; Viken, Oddbjørn

Further information

• DOI: 10.1016/j.sjpain.2010.05.017
• URN: urn:nbn:de:101:1-2024022313482811814532
• Rights: Open Access; Der Zugriff auf das Objekt ist unbeschränkt möglich.
• Last update: 14.08.2025, 10:46 AM CEST