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[Capnomediastinum after total extraperitoneal hernioplasty]
Nora Helene Wytrykowski Christensen1, Lars Lohne Eftang2, Marte Leland-Try3
1Gastroenterologisk kirurgi, Akershus universitetssykehus, og, Institutt for klinisk medisin, Universitetet i Oslo.
Background:
Capnomediastinum is a rare complication of laparoscopic total extraperitoneal hernioplasty. Laparoscopic surgery for groin hernias is common in the outpatient setting in Norway.
Case Presentation:
A healthy man in his forties underwent a total extraperitoneal left inguinal hernia repair under general anaesthesia. The procedure was uneventful, but the patient experienced syncope at home the following day. On readmission, he had mild tachypnoea, fever (38.1°C) and leukocytosis (18.2 × 109/L). A CT scan revealed subcutaneous emphysema and gas in the mediastinum, abdominal wall and intraperitoneal and retroperitoneal spaces. Based on clinical presentation and imaging, capnomediastinum was diagnosed. The patient was managed conservatively with oxygen therapy and observation, and was discharged in good condition.
Interpretation:
Total extraperitoneal hernia repair is a common procedure in which surgeons insufflate the preperitoneal space with CO2 gas. In some cases, the gas migrates, leading to cardiovascular or respiratory symptoms.
