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

Korean journal of anesthesiology
Hye-Jin ParkJi-Hye Kwon

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.

References

Jan 1, 1996·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·R W WahbaS J Kleiman
May 3, 2003·Thorax·M HenryUNKNOWN Pleural Diseases Group, Standards of Care Committee, British Thoracic Society
Apr 12, 2005·Surgical Laparoscopy, Endoscopy & Percutaneous Techniques·Anastasios J KarayiannakisConstantinos Simopoulos
Feb 6, 2009·Annals of Surgical Innovation and Research·Tarun SinghalShamsi El-Hasani
May 29, 2010·Korean journal of anesthesiology·Su-Man ChaGill-Hoi Koo
Sep 23, 2014·Korean journal of anesthesiology·Jin Kyoung Kim

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