Delayed presentation of gastric perforation after transesophageal echocardiography for cardiac surgery.

TRANSESOPHAGEAL echocardiography (TEE) is an integral tool for intraoperative monitoring and diagnosis in patients undergoing cardiac surgery. TEE remains a moderately invasive procedure with a very low incidence of complications, ranging from 0.2% to 1.2%. The spectrum of complications has included injury to the gastrointestinal tract, obstruction of airways, dysrhythmias, hemorrhage, or entrapment of other upper airway tubes. A common concern is that placement of the TEE probe in the anesthetized patient eliminates signs of severe patient discomfort that might herald or result from damage to gastrointestinal tissues. Consequently, contraindications to insertion of a TEE probe have included extensive esophageal disease, such as strictures, masses, diverticula, or untreated varices, as well as recent gastric hemorrhage, ulcers, masses, or symptomatic hiatal hernias. A history of preexisting esophageal or gastric disorder usually alerts physicians to avert complications. We report a case involving delayed presentation of gastric perforation at a rare site by TEE probe after cardiac surgery.