Free air after laparoscopic hysterectomy; from sigmoid perforation to upper airway compromise: a case report

Abstract

Background Free air after laparoscopic hysterectomy is a common finding; in rare cases, free air represents gastrointestinal perforation, requiring emergency laparotomy. Ectopic air localizations after pneumoperitoneum have been reported in various laparoscopic surgical techniques. Delayed diagnosis of visceral perforation is associated with high mortality rates. Case presentation We present a white Caucasian female in which dysphonia due to air entrapment in the cervical area, pneumomediastinum and pneumothorax, occured afterlaparoscopic hysterectomy. Conclusions Upon mobilization of the patient, air from sigmoid perforation moved cephalad. Through the same path, pneumoperitoneum, causes subcutaneous emphysema in the neck and face, pneumomediastinum and pneumothorax.

Postoperative abdominal free air: How much and when is enough? Report of two cases

“…Postoperative free air can be a puzzling finding especially when procedures involving iatrogenic insufflation of CO 2 are performed. 3 Initial intraperitoneal air has been reported to "travel" to various uncommon locations such as the mediastinum, neck and face, and scrotum, retroperitoneally or subcutaneously. [4][5][6] As far as post-laparoscopic pneumoperitoneum is concerned, it has been stated that it resolves within 3 days in 81% of the patients.…”

“…Postoperative free air can be a puzzling finding especially when procedures involving iatrogenic insufflation of CO 2 are performed. 3 …”

“…Among minimally invasive approaches (robotic/laparoscopic surgery, endoscopy), despite the evaluation of survival, perioperative and postoperative outcomes remain to be defined. 1 – 3 After written informed consent for publication, we report two cases of patients with postoperative free air along with the clinical presentation and management.…”