[Noncardiac ST elevation during the ileus operation]

A 59-year-old man had undergone the esophagectomy for esophageal carcinoma. Subsequently, he was scheduled to undergo the operation for ileus. He had midazolam 1 mg intramuscular injection before the surgery. General anesthesia was induced with thiamylal 62.5 mg and vecuronium 6 mg and maintained with sevoflurane, fentanyl, air and oxygen. ST elevation up to 0.3 mV occurred 45 minutes after the start of the operation, but his hemodynamic status was stable. We administered a nitrovasodilator, but the ST elevation rose gradually without hemodynamic instability until the end of the operation. He was then admitted to the cardiac care unit. The evidence of acute coronary syndrome (ACS) was not found, althrough the ST elevation did not decline to the baseline. Suddenly, a physician watching the patient and his ECG compressed his chest and interrupted its motion. Surprisingly, the ST elevation was improved. In this case, the gastric tube after esophagectomy had been extended to the ileus and the movement of the heart was influenced in the crowded mediastinal space. When ST elevation was found with no evidence of ACS, we must consider other reason than ACS.