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Ishikawa S, Hayashida M, Satoh D, Mine S, Kawagoe I. Persistent pneumothorax after laparoscopic appendectomy in a patient who had undergone radical esophagectomy 5 years before: possible relationship with vulnerability of the hiatus after esophagectomy: a case report. J Surg Case Rep 2024; 2024:rjae308. [PMID: 38764740 PMCID: PMC11102790 DOI: 10.1093/jscr/rjae308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 05/01/2024] [Indexed: 05/21/2024] Open
Abstract
Postoperative pneumothorax is a well-known but relatively rare complication after laparoscopic surgery. Herein, we report a case of persistent pneumothorax after laparoscopic appendectomy. A 57-year-old male, with a history of minimally invasive esophagectomy and intrathoracic gastric tube reconstruction 5 years before, underwent a laparoscopic appendectomy. A chest X-ray taken on postoperative Day 1 revealed the development of the right pneumothorax, which took more than 3 days to resolve spontaneously. Although the mechanism of postoperative pneumothorax was unclear, it seemed likely that the air that had replaced carbon dioxide in the peritoneal cavity migrated into the thoracic cavity through the esophageal hiatus, which was not covered by the peritoneum or pleura after surgical resection. The present case, together with our previous similar case, suggests that a history of esophageal cancer surgery per se increases the risk of pneumothorax after laparoscopic surgery, probably regardless of when this was performed.
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Affiliation(s)
- Seiji Ishikawa
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Juntendo University, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Masakazu Hayashida
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Juntendo University, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Daizo Satoh
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Juntendo University, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Shinji Mine
- Department of Esophageal and Gastroenterological Surgery, Faculty of Medicine, Juntendo University, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Izumi Kawagoe
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Juntendo University, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
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Ishikawa S, Shirakawa K, Kuroda Y, Yube Y, Mine S, Hayashida M, Kawagoe I. Persistent bilateral pneumothorax after robotic-assisted inguinal hernia repair: possible relevance to recent esophageal cancer surgery - a case report. JA Clin Rep 2023; 9:37. [PMID: 37347313 DOI: 10.1186/s40981-023-00630-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 06/10/2023] [Accepted: 06/12/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Postoperative pneumothorax is a well-known but relatively rare complication after laparoscopic surgery. There has been no report describing pneumothorax that persisted for a week or more after laparoscopic surgery. Herein, we report a case of bilateral pneumothorax after laparoscopic surgery, which appears to have occurred by a different mechanism than previously described. CASE PRESENTATION A 65-year-old male, with a past history of esophagectomy and retrosternal gastric tube reconstruction 4 months earlier, underwent a robotic-assisted inguinal hernia repair. Postoperative chest x-rays revealed the development of bilateral pneumothorax, which became worse on postoperative day (POD) 1 and took more than 9 days to resolve spontaneously. We assumed that intra-abdominal gas replaced by the air after pneumoperitoneum might have migrated into thoracic cavities through an opened esophageal hiatus or along the retrosternal route. CONCLUSIONS Laparoscopic surgery after radical esophagectomy may be associated with an increased risk of postoperative pneumothorax.
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Affiliation(s)
- Seiji Ishikawa
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Juntendo University, 2-1-1, Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan.
| | - Kaori Shirakawa
- Clinical Training Center, Juntendo University Hospital, 3-1-3, Hongo, Bunkyo-Ku, Tokyo, 113-8431, Japan
| | - Yui Kuroda
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Juntendo University, 2-1-1, Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Yukinori Yube
- Department of Esophageal and Gastroenterological Surgery, Faculty of Medicine, Juntendo University, 2-1-1, Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Shinji Mine
- Department of Esophageal and Gastroenterological Surgery, Faculty of Medicine, Juntendo University, 2-1-1, Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Masakazu Hayashida
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Juntendo University, 2-1-1, Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Izumi Kawagoe
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Juntendo University, 2-1-1, Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
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Fei Q, Lin Y, Yuan TM. Lung Ultrasound, a Better Choice for Neonatal Pneumothorax: A Systematic Review and Meta-analysis. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:359-369. [PMID: 33341304 DOI: 10.1016/j.ultrasmedbio.2020.11.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/24/2020] [Accepted: 11/16/2020] [Indexed: 06/12/2023]
Abstract
Neonatal pneumothorax is a life-threatening condition. Chest X-ray is the main diagnostic method but has some defects. Lung ultrasound has emerged as a diagnostic method in recent years. The aim of this review was to compare the diagnostic accuracy of lung ultrasound against chest X-ray in neonates with pneumothorax. We searched the Chinese journal full-text database, Wanfang database, China biomedical document service system, Weipu Chinese science and technology periodical full-text database, EMBASE, PubMed, The Cochrane Library and Web of Science (up to January 2020) for prospective studies on the diagnostic accuracy of lung ultrasound in neonates with pneumothorax. Statistical analysis was undertaken using Meta-DiSc software, version 1.4 (Romany Cajal Hospital, Madrid, Spain). The search returned 528 studies, of which 8 full texts were assessed for eligibility against the inclusion/exclusion criteria. The overall specificity and sensitivity of lung ultrasound in the diagnosis of neonatal pneumothorax was 98% (95% confidence interval [CI]: 0.94-0.99) and 99% (95% CI: 0.98-1.00), respectively. The diagnostic odds ratio was 920.01 (95% CI: 265.81-3184.33), and the area under the curve was 0.996 7 (Q* = 0.978 5). However, the chest X-ray was always taken as the reference standard with a sensitivity of 82% (95% CI: 0.72-0.90), a specificity of 96% (95% CI: 0.90-0.99) and a diagnostic odds ratio of 44.54 (95% CI: 4.30-460.98). Study analysis studies indicated that the sensitivity of lung ultrasound in diagnosing pneumothorax excepted chest X-ray as the single diagnosis criteria was 98% (95% CI: 0.93-1.00), the specificity was 100% (95% CI: 0.96-1.00) and the diagnostic odds ratio was 965.39 (95% CI: 161.195781.93), showing a higher accuracy than chest X-ray. In conclusion, lung ultrasound had better sensitivity and specificity than chest X-ray in the diagnosis of pneumothorax. Some ultrasonic signs (absence of lung sliding or B-lines) had a high sensitivity in the diagnosis, which could be used to diagnose pneumothorax. Lung point could help judge the severity of pneumothorax. Its presence indicates that pneumothorax is mild to moderate; otherwise, pneumothorax is severe.
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Affiliation(s)
- Qiang Fei
- Department of Neonatology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.
| | - Yu Lin
- Department of Neonatology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Tian-Ming Yuan
- Department of Neonatology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
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Mital T, Goyal S, Jain N, Sharma A. Use of lung ultrasound to diagnose intraoperative tension pneumothorax in a pediatric laparoscopic surgery. Saudi J Anaesth 2020; 14:563-564. [PMID: 33447218 PMCID: PMC7796724 DOI: 10.4103/sja.sja_448_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 05/08/2020] [Indexed: 12/25/2022] Open
Affiliation(s)
- Tanya Mital
- Department of Anaesthesiology and Critical Care, AIIMS Jodhpur, Rajasthan, India
| | - Shilpa Goyal
- Department of Anaesthesiology and Critical Care, AIIMS Jodhpur, Rajasthan, India
| | - Nidhi Jain
- Department of Anaesthesiology and Critical Care, AIIMS Jodhpur, Rajasthan, India
| | - Ankur Sharma
- Department of Anaesthesiology and Critical Care, AIIMS Jodhpur, Rajasthan, India
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Heyba M, Rashad A, Al-Fadhli AA. Detection and Management of Intraoperative Pneumothorax during Laparoscopic Cholecystectomy. Case Rep Anesthesiol 2020; 2020:9273903. [PMID: 32318295 PMCID: PMC7166272 DOI: 10.1155/2020/9273903] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 03/16/2020] [Indexed: 01/02/2023] Open
Abstract
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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Affiliation(s)
| | - Areej Rashad
- Department of Anesthesia and Intensive Care, Farwaniya Hospital, Sabah Al Nasser, Kuwait
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