Korean J Anesthesiol.  2016 Feb;69(1):88-92. 10.4097/kjae.2016.69.1.88.

Carbon dioxide pneumothorax occurring during laparoscopy-assisted gastrectomy due to a congenital diaphragmatic defect: a case report

• Park HJ
• Kim DK
• Yang MK
• Seo JE
• Kwon JH

• KMID: 2152868
• DOI: http://doi.org/10.4097/kjae.2016.69.1.88

Abstract

During laparoscopic surgery, carbon dioxide (CO2) pneumothorax can develop due to a congenital defect in the diaphragm. We present a case of a spontaneous massive left-sided pneumothorax that occurred during laparoscopy-assisted gastrectomy, because of an escape of intraperitoneal CO2 gas, under pressure, into the pleural cavity through a congenital defect in the esophageal hiatus of the left diaphragm. This was confirmed on intraoperative chest radiography and laparoscopic inspection. This CO2 pneumothorax caused tolerable hemodynamic and respiratory consequences, and was rapidly reversible after release of the pneumoperitoneum. Thus, a conservative approach was adopted, and the remainder of the surgery was completed, laparoscopically. Due to the high solubility of CO2 gas and the extra-pulmonary mechanism, CO2 pneumothorax with otherwise hemodynamically stable conditions can be managed by conservative modalities, avoiding unnecessary chest tube insertion or conversion to an open procedure.

Keyword

Carbon dioxide; Laparoscopic surgery; Pneumoperitoneum; Pneumothorax

MeSH Terms

Carbon Dioxide*
Carbon*
Chest Tubes
Congenital Abnormalities
Conversion to Open Surgery
Diaphragm
Gastrectomy*
Hemodynamics
Laparoscopy
Pleural Cavity
Pneumoperitoneum
Pneumothorax*
Radiography
Solubility
Thorax
United Nations
Carbon
Carbon Dioxide