Severe subcutaneous emphysema caused by small injury to the abdominal wall during robot-assisted laparoscopic radical prostatectomy

Abstract

A 67-year-old man underwent RARP in the Trendelenburg position with pneumoperitoneum at 12 mmHg. Gradual elevation of End-tidal CO2(EtCO2) began, and extensive subcutaneous emphysema was recognized when EtCO2 reached 58 mmHg. After interruption of pneumoperitoneum, careful observation of the surgical field led to detect an injury of the abdominal wall of 1 cm in length, suggesting the cause of severe subcutaneous emphysema. The injury was repaired and RARP was terminated without any cardiovascular problems. Attention should be paid that even minor abdominal wall injury could lead to severe subcutaneous emphysema which may cause respiratory or cardiovascular problems during laparoscopic surgeries.

Using LAP PROTECTOR™ to prevent subcutaneous emphysema after robotic gastrectomy

“…McAllister et al [13] reported that the 24-hour postoperative computed tomography scans of patients who underwent laparoscopic cholecystectomy revealed grossly undetectable but clinical SE in 56% of cases. Similarly, Worrell, Saggar, and colleagues recognized SE in up to 99% of all laparoscopic cases based on radiographic ndings and computed tomography scans [1,9,[13][14][15][16]]. The reported life-threatening complications and high incidence of clinically relevant SE (21%), including two abdominal infections caused by SE in our study, indicate that this complication deserves immediate consideration [1][2][3][4][5][6].…”

Micturition Disturbance: A Predominant Feature of Acute Disseminated Encephalomyelitis

“…3 4 Micturition disturbance has been described in children with ADEM, but isolated urinary retention as an initial manifestation is extremely rare. 5…”

“…1 Fukui et al from Japan described an 11-year-old boy presenting with acute urinary retention, fever, headache, and weakness of the extremities with MRI findings suggestive of ADEM. 5 Within 7 days of steroid initiation therapy, the child could void urine normally. Improvement of lesions on MRI was observed on day 14 of admission.…”

“…Improvement of lesions on MRI was observed on day 14 of admission. 5 Doria Lamba et al described a 14-year-old boy who presented with acute urinary retention and fever with unremarkable neurological examination with MRI findings showing ADEM features. 6 Steroid therapy brought about clinical recovery in a few days and resolution of lesions on MRI after 4 months.…”

“…2 Urinary retention though reported in this condition, it is an uncommon presenting feature. 3 4 5 The diagnosis of ADEM is based on the clinical features and characteristic findings of hyperintense lesions in the magnetic resonance imaging (MRI) of the brain. 2 Here, we report an adolescent boy brought with isolated acute urinary retention as the sole presenting complaint that was subsequently diagnosed to be ADEM.…”