Ventilatory impairment during laparoscopic cholecystectomy in a patient with a ventriculoperitoneal shunt

A patient with a recently placed ventriculoperitoneal shunt suffered ventilatory impairment due to decreased thoracic compliance related to massive subcutaneous emphysema during laparoscopic cholecystectomy. The patient recovered uneventfully; however, recently established closed communication between the peritoneal cavity and the subcutaneous space may be a relative contraindication to laparoscopic surgery.