Hydrothorax: an unexpected complication after laparoscopic myomectomy

Kanno, Toshiyuki; Yoshikawa, Daisuke; Tomioka, Akihiro; Kamijyo, Takehiko; Yamada, Kazuya; Goto, Fumiyuki

doi:10.1093/bja/87.3.507

Cited by 16 publications

(13 citation statements)

References 9 publications

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“…Hydrothorax complicating peritoneal dialysis is also well reported 4 . The prevalence of hydrothorax in cases of liver cirrhosis and peritoneal dialysis is 6 and 2% respectively 6 . Over the period of 3 months, when these three cases underwent their surgery, a total of 49 cases of operative laparoscopy were carried out in our unit.…”

Section: Discussionmentioning

confidence: 81%

Pleural effusion following use of saline and fluid anti‐adhesion agents at laparoscopic surgery—a case series of three patients

Ronghe¹,

Bjornsson²,

Hannah

2009

BJOG

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Please cite this paper as: Ronghe R, Bjornsson S, Hannah P. Pleural effusion following use of saline and fluid anti-adhesion agents at laparoscopic surgery-a case series of three patients. BJOG 2009;116:1524-1526. Case reportLaparoscopy is widely used for diagnostic as well as therapeutic purposes in gynaecology. The green top guidelines on the management of endometriosis produced by the Royal College of Obstetricians and Gynaecologists recommend advanced laparoscopic surgery for treatment of severe endometriosis. Here, we present three very unusual cases of hydrothorax developed as a complication of advanced laparoscopic surgery for endometriosis.The first patient was a 38-year-old nulliparous woman with BMI of 25.7 with known severe endometriosis referred to gynaecology clinic for consideration of advanced laparoscopic surgery. The patient had undergone diagnostic laparoscopy with no complications in the past. She was fit with no significant past medical history. Preoperative investigations were unremarkable.The patient was intubated, paralysed and ventilated during the operation. She was in lithotomy position with modest Trendlenburg tilt. An average intraperitoneal pressure of 15 mmHg was maintained during the procedure.Introperatively, she was found to have stage IV endometriosis with dense adhesions involving both tubes and ovaries. Laparoscopic adhesiolysis and laser treatment of endometriosis was carried out. The procedure lasted for 1 hour. A total of 3 l of normal saline were used for suction irrigation. Although the exact irrigation balance was not recorded, it was assumed that the majority of the fluid was recovered. At the end of the procedure, 1.5 l of ADEPT (4% icodextrin) was left in the peritoneal cavity.About 40-45 minutes into the operation, it became difficult to ventilate the patient. Her airway pressure increased, end tidal CO 2 increased and oxygen saturation dropped from 100 to 90% on an FiO 2 of 0.5. This occurred over a period of 5-10 minutes. Saturations improved to 96% on 100% oxygen. At this stage, almost 2500 ml of saline had been used for irrigation. On auscultation, breath sounds were present bilaterally. The operation was completed in the next 20 minutes. The patient required to be ventilated with 100% oxygen to maintain saturations over 90%. It was deemed unsafe to extubate the patient. Arterial blood gas analysis showed Po 2 of 11.2 kPa and Pco 2 of 7.8 kPa on 100% oxygen with 5 cm positive end-expiratory pressure (PEEP).At this stage, breath sounds were noticed to be diminished over the right side of the chest. A portable chest X-ray showed a white out of the right side (Figure 1). An ultrasound scan was performed, which demonstrated the presence of a large amount of fluid in the right hemithorax. A chest drain was inserted in the right pleural cavity and immediately, almost a litre of fluid was drained.Repeat arterial blood gas analysis showed Po 2 of 43.2 kPa and Pco 2 of 5.3 kPa.The right lung did not inflate adequately and thus the patient was transferred to ITU. She was v...

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Section: Discussionmentioning

confidence: 81%

Pleural effusion following use of saline and fluid anti‐adhesion agents at laparoscopic surgery—a case series of three patients

Ronghe¹,

Bjornsson²,

Hannah

2009

BJOG

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“…In other cases, it was also reported that a hydrothorax occurred after gynecologic laparoscopical surgery [9,10]. A massive hydrothorax was produced during surgery, particularly at the right-sided chest.…”

Section: Discussionmentioning

confidence: 88%

Unilateral massive hydrothorax in a gynecologic patient with pseudo-Meigs' syndrome -A case report-

Hahm

Ham

Kang

2010

Korean J Anesthesiol

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Pseudo-Meigs' syndrome is characterized by the presence of a benign ovarian tumor associated with ascites and a right-sided hydrothorax. The major problem associated with pseudo-Meigs' syndrome is the respiratory distress caused by a giant mass in the peritoneal space, massive ascites and pleural effusion. Even if there are no respiratory problems prior to surgery, potential respiratory dysfunction can occur during the peri-anesthetic period, leading to hypoxia, hypercapnea and respiratory acidosis. We report a case of hypoxia during recovery from anesthesia in a gynecological patient with pseudo-Meigs' syndrome.

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“…This pathology is termed as porous diaphragm syndrome [3,4]. This may lead to transfer of gases or fluids into the thoracic cavity from abdomen [5]. The gases can also travel through the esophageal hiatus into the mediastinum and pleura [6].…”

Section: Discussionmentioning

confidence: 99%

Breaking the Diaphragmatic Barrier: Unilateral Pneumothorax and Hemothorax after Laparoscopic Myomectomy

Meshram¹,

Jain²,

Khanna³

2017

J Anesth Clin Res

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Laparoscopic surgeries can be associated with thoracic complications like pneumothorax and hemothorax. During laparoscopy, opening of pleura-peritoneal channels and defects in the diaphragm can occur termed as porous diaphragm syndrome and can result in pneumothorax. A 30 yr old woman undergoing laparoscopic myomectomy for uterine fibroid developed hemopneumothorax secondary to porous diaphragm syndrome in the post-operative period. ICD insertion and fluid resuscitation effectively treated this condition. The anesthetist and surgeon should be vigilant about these serious thoracic complications of laparoscopy and have knowledge on management of these conditions.

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Hydrothorax: an unexpected complication after laparoscopic myomectomy

Cited by 16 publications

References 9 publications

Pleural effusion following use of saline and fluid anti‐adhesion agents at laparoscopic surgery—a case series of three patients

Pleural effusion following use of saline and fluid anti‐adhesion agents at laparoscopic surgery—a case series of three patients

Unilateral massive hydrothorax in a gynecologic patient with pseudo-Meigs' syndrome -A case report-

Breaking the Diaphragmatic Barrier: Unilateral Pneumothorax and Hemothorax after Laparoscopic Myomectomy

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