Use of intraoperative ultrasonography for identification and management of pneumothorax caused by iatrogenic diaphragm defect: a case report and literature review

Han, Qiang; Wang, Beibei; Xu, Aiguo

doi:10.1177/0300060519898048

Cited by 7 publications

(6 citation statements)

References 32 publications

(51 reference statements)

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“…In such case, the air from pneumoperitoneum would continue to leak through the diaphragmatic injury to the thoracic cavity and then through the intercostal tube to the underwater drainage system; this did not happen in our case, in which pneumoperitoneum was achieved successfully after intercostal tube insertion. On the other hand, a small diaphragmatic injury, caused by dissection instruments or Veress needle, for instance, which can heal spontaneously [25], could have happened in our patient. e presence of diaphragmatic injury could not be confirmed or excluded by the postoperative CT, as the gold standard for diagnosing and treating diaphragmatic injury is surgical exploration and repair, either open or laparoscopic [23,25].…”

Section: Discussionmentioning

confidence: 63%

“…On the other hand, a small diaphragmatic injury, caused by dissection instruments or Veress needle, for instance, which can heal spontaneously [25], could have happened in our patient. e presence of diaphragmatic injury could not be confirmed or excluded by the postoperative CT, as the gold standard for diagnosing and treating diaphragmatic injury is surgical exploration and repair, either open or laparoscopic [23,25]. In our patient, the surgeons did not report observing any diaphragmatic injuries afterwards during laparoscopy.…”

Section: Discussionmentioning

confidence: 63%

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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: 63%

Section: Discussionmentioning

confidence: 63%

Detection and Management of Intraoperative Pneumothorax during Laparoscopic Cholecystectomy

Heyba

Rashad

Al-Fadhli

2020

Case Reports in Anesthesiology

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“…Iatrogenic causes include rupture of pulmonary bullae caused by barotrauma or mechanical ventilation, injury of diaphragm or pleura caused by surgical operation, including argon knife, electric knife hemostasis, and injury of pulmonary apex caused by central venous catheterization 11,12 . Other factors, including high ETCO 2 level (≥ 50 mmHg), extended operation time (≥ 200 minutes) and fast and high CO 2 insu ation pressure, may lead to intraoperative pneumothorax 13,14 .…”

Section: Discussionmentioning

confidence: 99%

Intraoperative transthoracic ultrasound in the differential diagnosis of small hepatectomy-induced pneumothorax

Huang

Yao³

et al. 2023

Preprint

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Transthoracic ultrasound is widely used in to diagnose and treat lung diseases, such as pneumonia, atelectasis, pneumothorax and pulmonary edema. Recently, intraoperative transthoracic ultrasound was used to promptly identify two cases of early pneumothorax in patients that underwent liver surgery. We documented the process of pneumothorax occurrence and the patient outcomes. Timely discovery and effective real-time monitoring and evaluation of the scope of pneumothorax ensured the smooth completion of the operation and successfully avoided closed thoracic drainage in one case, avoiding further patient trauma. Indeed, intraoperative ultrasound is an effective approach to diagnose and evaluate pneumothorax that does not affect the progress of surgery and is more convenient and sensitive than conventional chest radiography.

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“…Using transthoracic ultrasonography is an appealing and fast way to confirm the presence of PTX compared to the conventional x-ray. 7 The management of PTX developing during laparoscopy ranged from conservative management such as the evacuation of the pneumoperitoneum, using positive endexpiratory pressure (PEEP) intercostal cannulas, to chest tube insertion other options. Include attempting to repair the pleural injury if accessible.…”

Section: Discussionmentioning

confidence: 99%

Controlling intraoperative laparoscopy-induced pneumothorax using a novel technique

2022

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Pneumothorax (PTX) is defined as an abnormal accumulation of gas in the pleural space. There is a potential development of PTX during laparoscopy since gas insufflation is used. Management options are available to control PTX intraoperatively, and herein we describe a new technique that can be implemented with unique features. A 32-year-old patient with morbid obesity was scheduled for laparoscopic adjustable gastric band (AGB) removal and laparoscopic sleeve gastrectomy (LSG). During the removal of AGB, a hiatal hernia was noticed. Dissection of the hernia led to PTX. Images were collected from the procedure video to describe our technique in controlling laparoscopy-induced PTX. Upon noticing PTX, actions were taken promptly using our technique. The anesthesia team was alerted, the abdomen was deflated, and the table was positioned to Trendelenburg. The PTX was controlled using a 14fr feeding tube advanced through the dissected esophageal hiatus, with the external end submerged under saline. The procedure was completed with no complications. Our technique in controlling laparoscopy-induced PTX is effective in certain situations. The technique assures completing the procedure without hindrance with minimal morbidity.

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Use of intraoperative ultrasonography for identification and management of pneumothorax caused by iatrogenic diaphragm defect: a case report and literature review

Cited by 7 publications

References 32 publications

Detection and Management of Intraoperative Pneumothorax during Laparoscopic Cholecystectomy

Detection and Management of Intraoperative Pneumothorax during Laparoscopic Cholecystectomy

Intraoperative transthoracic ultrasound in the differential diagnosis of small hepatectomy-induced pneumothorax

Controlling intraoperative laparoscopy-induced pneumothorax using a novel technique

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