Pneumothorax during Laparoscopic Cholecystectomy

Kumar, Gaurav; Ak, Singh

doi:10.1016/s0377-1237(07)80155-9

Cited by 8 publications

(5 citation statements)

References 3 publications

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“…Factors that contribute to the development of pneumothorax during laparoscopy include leak of carbon dioxide from the peritoneal cavity into the pleural cavity either by diffusion or through a congenital defect in the diaphragm [18,20]. Another risk factor related to laparoscopic surgery is diaphragmatic injury, due to surgical port insertion through the diaphragm, or through direct damage during manipulation of the liver during dissection of the gallbladder from its bed [19,21,22]. In our patient, the presence of right lobe liver laceration that was found in the postoperative CT scan might indicate surgical injury to the diaphragm; however, the presence of large diaphragmatic injury is unlikely because it would have been difficult to achieve pneumoperitoneum after intercostal tube insertion [23,24].…”

Section: Discussionmentioning

confidence: 99%

Detection and Management of Intraoperative Pneumothorax during Laparoscopic Cholecystectomy

Heyba

Rashad

Al-Fadhli

2020

Case Reports in Anesthesiology

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Intraoperative pneumothorax is a rare but potentially lethal complication during general anesthesia. History of lung disease, barotrauma, and laparoscopic surgery increase the risk of developing intraoperative pneumothorax. The diagnosis during surgery could be difficult because the signs are often nonspecific. We report a case of a middle-aged gentleman who developed right pneumothorax during an elective laparoscopic cholecystectomy. The patient had no risk factors for adverse events during the preoperative assessment (ASA1). The patient underwent general anesthesia and was put on mechanical ventilation. The first signs of abnormality immediately after surgical port insertion were tachycardia and low oxygen saturation in addition to sings of airway obstruction. The diagnosis of pneumothorax was made clinically by chest auscultation and later confirmed by intraoperative chest radiograph. Supportive treatment was started immediately through halting the surgery and manually ventilating the patient using 100% oxygen. Definitive treatment was then done by inserting an intercostal tube. After stabilizing the patient, the surgery was completed; then, the patient was extubated and shifted to the surgical ward. Postoperative computed tomography (CT) scan was done and showed only minimal liver laceration. The patient was discharged after removing the intercostal tube and was stable at the follow-up visit. Therefore, it is important to have a high index of suspicion to early detect and treat such complication. In addition, good communication with the surgeon and use of available diagnostic tools will aid in the proper management of such cases.

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Section: Discussionmentioning

confidence: 99%

Detection and Management of Intraoperative Pneumothorax during Laparoscopic Cholecystectomy

Heyba

Rashad

Al-Fadhli

2020

Case Reports in Anesthesiology

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“…On the other hand, a possibility that barotrauma due to positive pressure ventilation is the cause is unable to be denied. Reports show the risk of pneumothorax due to positive pressure ventilation, even though no excessive positive airway pressure is observed [7–11].…”

Section: Discussionmentioning

confidence: 99%

A successful surgical repair of intraoperative pneumothorax and the diffuse dissection of visceral pleura during liver transplantation surgery via trans-diaphragmatic approach

et al. 2019

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BackgroundPneumothorax during surgery under general anesthesia is a life-threatening situation for the patient because it can progress easily to the tension pneumothorax due to positive pressure ventilation unless appropriate treatments such as inserting a drainage tube in the thoracic cavity are initiated. The authors experienced a case of intraoperative pneumothorax and the diffuse dissection of visceral pleura during liver transplantation surgery, and achieved successful repair by a trans-diaphragmatic approach without changing patient’s body position.Case presentationA 66-year-old male with multiple liver and renal cysts caused by autosomal dominant polycystic kidney disease (ADPKD) was admitted to the authors’ hospital for treating the infection of the liver cysts. The infection was unable to be controlled by conservative treatments. Therefore, the patient was planned to undergo living-donor liver transplantation. Intraoperatively, the liver was found to swell markedly and to firmly adhere to the right diaphragm. After the extraction of the liver, because the right diaphragm swelled markedly, pneumothorax was suspected. Chest tube was inserted immediately, and the small incision was made in the right diaphragm. Thoracoscopic observation revealed that (1) the visceral pleura of the bottom of the right lung widely expanded like a giant cyst due to the dissection from the lung parenchyma and (2) a large air leakage from a pin hole appeared in the dissected pleura. After the completion of the liver transplantation, the thoracoscopic leakage-closing operation was performed through the right diaphragm incision. Because the dissection of visceral pleura was too wide to perform plication or cystectomy by a stapler or sutures, the dissected pleura was opened, and absorbable fibrin sealant patches and fibrin glue were put or injected between the lung parenchyma and the pleura. Although, after being observed postoperatively, prolonged minor air leakage disappeared by a conservative drainage treatment, and the cyst on the bottom of the right lung disappeared on chest computed tomography (CT).ConclusionsAlthough intraoperative pneumothorax and broad dissection of visceral pleura during laparotomy is a complicated situation, the authors successfully repaired air leakage via a trans-diaphragmatic approach without changing the patient’s body position.

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“…An intercostal chest tube may have to be placed. 7 A postoperative chest X-ray is a must. Any signs of postoperative tachycpnea, tachycardia, and fall in saturation should be treated immediately, and sometimes a postoperative ICD (implantable cardiac defibrillator) may have to be placed.…”

Section: Discussionmentioning

confidence: 99%

“…If detected toward the end of the procedure in a stable patient, the operation should be completed and nothing further needs to be done, as the carbon dioxide in the pleural cavity gets reabsorbed rapidly after deflating the abdomen. 7 In any case, serial X-rays may be required and the patient should be observed. Serial arterial blood gas may be required.…”

Section: Discussionmentioning

confidence: 99%

Pneumothorax during Cardiomyotomy: Management

Nayak¹

2016

Journal of Research &Amp; Innovation in Anesthesia

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Laparoscopic cardiomyotomy is the surgical mode of treatment for patients suffering from achalasia cardia. These patients are at a risk of developing intraoperative pneumothorax with hemodynamic and respiratory changes. We reported case of pneumothorax during laparoscopic cardiomyotomy. Patient developed hypotension, tachycardia, decreased air entry and increased peak airway pressure. We managed that case successfully. Hemodynamics was maintained with fluid and ephedrine. Patient was ventilated with 100% Oxygen and put on pressure cycled ventilator mode. Postoperatively patient was observed in ICU. While managing such cases, anesthetists should be aware of this complication and be vigilant. How to cite this article Nayak S. Pneumothorax during Cardiomyotomy: Management. Res Inno in Anesth 2016;1(2): 71-72.

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Pneumothorax during Laparoscopic Cholecystectomy

Cited by 8 publications

References 3 publications

Detection and Management of Intraoperative Pneumothorax during Laparoscopic Cholecystectomy

Detection and Management of Intraoperative Pneumothorax during Laparoscopic Cholecystectomy

A successful surgical repair of intraoperative pneumothorax and the diffuse dissection of visceral pleura during liver transplantation surgery via trans-diaphragmatic approach

Pneumothorax during Cardiomyotomy: Management

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