Laparoscopy-pneumothorax and ocular emphysema, a rare complication-a case report

Area of Science:

• Medical and Surgical Procedures
• Anesthesiology
• Thoracic Surgery

Background:

• Diagnostic laparoscopy involves insufflating the abdominal cavity with carbon dioxide gas.
• Complications like pneumomediastinum are rare but serious adverse events during general anesthesia.
• Understanding the potential pathways for gas extravasation is crucial for patient safety.

Observation:

• A 21-year-old female patient undergoing diagnostic laparoscopy for infertility developed pneumomediastinum, pneumothorax, and ocular emphysema shortly after carbon dioxide insufflation.
• These conditions manifested immediately following the initial gas insufflation phase of the procedure.
• The patient's symptoms indicated a significant and rapid spread of carbon dioxide outside the peritoneal cavity.

Findings:

• The extravasation of carbon dioxide from the intraperitoneal space into the mediastinum was identified as the cause.
• A potential defect in the diaphragm was hypothesized as the route for carbon dioxide traversal.
• Resolution of symptoms was achieved through abdominal deflation and chest tube decompression.

Implications:

• This case highlights a rare but critical complication associated with carbon dioxide insufflation during laparoscopic procedures.
• The findings underscore the importance of recognizing diaphragmatic defects as a potential pathway for gas embolism.
• Prompt diagnosis and management, including deflation and decompression, are essential for favorable outcomes in such rare events.