**15. Conclusions**

this broad pathophysiologic spectrum, gastrointestinal infection and associated manifesta‐ tions feature prominently. While a complete discussion of this topic is beyond the scope of this chapter, we thought it would be important to mention some of the more prominent among these post-transplant sequelae. The list of potential gastrointestinal complications seen after solid organ transplantation is diverse, including cytomegalovirus enteritis [65], herpes simplex virus mucocutaneous manifestations [66], candidal esophagitis [67], *Clostri‐ dium difficile* and *Yersinia enterocolitica* infections [4], parasitic (protozoan/metazoan) enteritis [67], and *Helicobacter pylori* infection [68]. Among other post-transplant gastrointestinal com‐ plications, organ recipients may be more likely to exhibit diarrhea, luminal ulcerations, per‐ forations, biliary tract complaints, pancreatitis, and gastrointestinal malignancy (i.e., posttransplant lymphoproliferative disorder) [65, 69]. For more detail regarding post-transplant and immunosuppresion-related gastrointestinal complications among heart and lung recipi‐ ents, the reader is referred to more specialized literature on this expansive topic [65, 67, 68].

**14. Miscellaneous gastrointestinal and abdominal complications related**

Among less commonly encountered (and reported) complications of cardiac surgery are those associated with trans-esophageal echocardiography (TEE). Likely under-reported, TEE-related complications in cardiac surgical patients occur in as many as 1.2% of patients [70]. In one series, esophageal and gastric tears were seen within 24 hours of the TEE in 2 patients, with additional gastric ulceration and gastric tear seen within 5 days of the proce‐ dure. Moreover, gastric perforations were described presenting between 4-11 days post-TEE. Among the 6 reported cases, 3 required a laparotomy, 2 were treated endoscopically,

Epigastric (sub-xiphoid) and chest tube site hernias [71] following cardiac surgery occur in as many as 3-4% of patients following median sternotomy [72]. Another, much less common com‐ plications related to the mediastinal tube thoracostomy is superior epigastric artery pseudoa‐ neurysm [73]. Management of these rare conditions is mostly surgical, although minimally

Due to the growing volume of mechanical cardiac and pulmonary assistive technologies (i.e., ventricular assist devices, intra-aortic balloon pumps, extra-corporeal membrane oxy‐ genation devices), it is important to mention potential gastrointestinal and abdominal com‐ plications associated with these devices. Not unexpectedly, the use of cardio-respiratory mechanical assistive devices has been found to be associated with clinically significant ab‐ dominal and gastrointestinal complications [32, 74, 75]. For example, extracorporeal mem‐ brane oxygenation has been associated with embolic phenomena of the systemic circulation, end-organ ischemia, gastrointestinal hemorrhage, and abdominal compartment syndrome [74, 76-78]. Patients who undergo ventricular assist device placement are also exposed to a number of potential gastrointestinal and abdominal complications, including abdominal in‐ fection, bowel injury, acalculous cholecystitis, pancreatitis, various hernias (i.e., incisional,

symptomatic high-risk surgical patients may be followed with clinical observation.

**to cardiac surgery**

364 Principles and Practice of Cardiothoracic Surgery

and 1 patient required transfusion [70].

Gastrointestinal complications following cardio-thoracic procedures continue to significant‐ ly contribute to morbidity and mortality in this patient population. Preventive strategies, coupled with early recognition and aggressive management of GIC-CTS constitute the foun‐ dation of the general clinical approach to these complications. Therefore, it is imperative that all practitioners who care for postoperative cardiac and thoracic surgical patients are fa‐ miliar with the full spectrum of potential gastrointestinal complications in this patient popu‐ lation, as well as with general therapeutic approaches to these complications.
