Subcutaneous emphysema, pneumomediastinum and pneumothorax complicating laparoscopic vagotomy

Abstract

Two patients developed subcutaneous emphysema and pneumomediastinum during laparoscopic vagotomy. One of the patients also had a pneumothorax which produced a sudden increase in end-tidal carbon dioxide concentration preceding arterial oxygen desaturation. The pneumothorax was drained with an intercostal cannula. The patient required a twofold increase in minute ventilation to maintain normocarbia, probably because of the additional absorption of carbon dioxide through the pleural cavity. Despite the presence of a peritoneopleural communication, surgery was successfully completed. We believe that gas under tension in the peritoneal cavity dissected along tissue planes around the oesophagus opened up during surgery. Thus pneumomediastinum, subcutaneous emphysema and pneumothorax are dejnite risks associated with this new procedure.

Fast-track management of pneumothorax in laparoscopic surgery

“…Most of the reported cases were diagnosed by the postoperative desaturation or intraoperative haemodynamic instability. [4–6] In our case, an early identification and the limitation of the pneumoperitonium pressure helped to avoid the haemodynamic instability. Carbon dioxide is an easily diffusible gas, so an inter costal drain (ICD) insertion is unnecessary in a haemodynamically stable patient.…”

Capnothorax during laparoscopic fundoplication: Diagnosis and anesthetic management

“…The other differential diagnosis is subcutaneous emphysema, which can be confirmed by clinical examination. [7,8] We have described a case of spontaneous capnothorax in ASA Grade I patient undergoing laparoscopic fundoplication. The first sign was increased etCO 2 despite adjustments in minute ventilation followed by increase in Paw and falling saturation.…”

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

“…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].…”