Capnothorax During Laparoscopy in Trendelenburg Position: A Rare Case Study

Area of Science:

• Surgical Complications
• Laparoscopic Surgery
• Pulmonary Complications

Background:

• Pneumothorax is an infrequent complication of laparoscopic surgery, typically occurring during upper abdominal procedures due to the Trendelenburg position.
• CO2 diffusion across congenital diaphragmatic defects can cause pneumothorax, often resolving spontaneously after pneumoperitoneum de-insufflation.

Observation:

• A case of right-sided hypertensive capnothorax occurred during lower abdominal laparoscopic surgery.
• The condition was attributed to a diaphragmatic defect.

Findings:

• The hypertensive capnothorax was successfully managed without requiring chest drainage.
• Increasing positive end-expiratory pressure was an effective measure after excluding a pulmonary origin.

Implications:

• This case underscores the importance of maintaining vigilance and a high index of suspicion for pneumothorax during laparoscopic surgery.
• Non-invasive management of capnothorax is possible in select cases, potentially avoiding chest tube insertion.