Pneumomediastinum and subcutaneous emphysema after successful laparoscopic supra-cervical hysterectomy

Free air after laparoscopic hysterectomy; from sigmoid perforation to upper airway compromise: a case report

BACKGROUND

Free air after laparoscopic hysterectomy is a common finding; in rare cases, free air represents gastrointestinal perforation, requiring emergency laparotomy. Ectopic air localizations after pneumoperitoneum have been reported in various laparoscopic surgical techniques. Delayed diagnosis of visceral perforation is associated with high mortality rates.

CASE PRESENTATION

We present a white Caucasian female in which dysphonia due to air entrapment in the cervical area, pneumomediastinum and pneumothorax, occured afterlaparoscopic hysterectomy.

CONCLUSIONS

Upon mobilization of the patient, air from sigmoid perforation moved cephalad. Through the same path, pneumoperitoneum, causes subcutaneous emphysema in the neck and face, pneumomediastinum and pneumothorax.

Pneumomediastinum and ECG changes during laparoscopic Nissen fundoplication in a child; Case report

INTRODUCTION

Laparoscopic surgeries are becoming more popular in many surgical procedures particularly in pediatric age group. The physical responses and hemodynamic changes that occur during laparoscopic surgery differ between adults and pediatrics.

CASE PRESENTATION

We report a sudden hemodynamic instability and abrupt ECG changes associated with pneumomediastinum (PM) during laparoscopic Nissen fundoplication surgery in a 19 months old boy who had gastro-esophageal reflux disease. Procedure was converted to open surgery and all parameters were spontaneously returned back to normal values. The patient was successfully extubated then transferred to intensive care unit (ICU) for close monitoring. He had uneventful post-operative course where PM has been completely resolved in the repeated chest x-ray.

DISCUSSION

Pneumomediastinum (PM) occurs when air escape into the mediastinum. This air might reach the pericardium causing hemodynamic and electrophysiological changes. It is one of the reported complications that might occur during laparoscopic surgery, however isolated PM usually resolve spontaneously without any intervention. Etiology and possible contributing factors were discussed.

CONCLUSION

Pneumoperitonium leads to different hemodynamic changes during laparoscopic surgery in pediatric population compared to adults. Decreasing the insufflation pressure and patient's re-positioning might make continuing laparoscopy safe. However, surgeon must be willing to convert to open surgery to prevent any further complications.