Reexpansion Pulmonary Edema following Laparoscopy-Assisted Distal Gastrectomy for a Patient with Early Gastric Cancer: A Case Report

Abstract

We report here a case of reexpansion pulmonary edema following laparoscopy-assisted distal gastrectomy (LADG) for early gastric cancer. A 57-year-old Japanese woman with no preoperative comorbidity was diagnosed with early gastric cancer. The patient underwent LADG using the pneumoperitoneum method. During surgery, the patient was unintentionally subjected to single-lung ventilation for approximately 247 minutes due to intratracheal tube dislocation. One hour after surgery, she developed severe dyspnea and produced a large amount of pink frothy sputum. Chest radiography results showed diffuse ground-glass attenuation and alveolar consolidation in both lungs without cardiomegaly. A diagnosis of pulmonary edema was made, and the patient was immediately intubated and received ventilatory support with high positive end-expiratory pressure. The patient gradually recovered and was weaned from the ventilatory support on the third postoperative day. This case shows that single-lung ventilation may be a risk factor for reexpansion pulmonary edema during laparoscopic surgery with pneumoperitoneum.

Lung ultrasound score evaluation of the effect of pressure-controlled ventilation volume-guaranteed on patients undergoing laparoscopic-assisted radical gastrectomy

“…Laparoscopic-assisted radical gastrectomy (LARG), the standard treatment for early-stage GC, is advantageous over conventional open gastrectomy in minimal invasiveness, good visualization, lesser intraoperative bleeding, and faster postoperative recovery[ 6 , 7 ]. However, anesthesia, mechanical synchronization, and other factors involved in the procedure may induce various negative effects on the patient’s respiratory function and cause adverse events, such as abnormal blood gas analysis indexes, uneven pulmonary ventilation, and postoperative pulmonary complications (PPCs)[ 8 , 9 ].…”