Tension pneumothorax and pneumoperitoneum following shoulder arthroscopy in a single-lung patient: A case report

Shoulder arthroscopy is generally considered a low-risk procedure; however, complications related to patient positioning, positive-pressure ventilation, and general anesthesia may arise, particularly in high-risk patients.

We report the case of a 57-year-old man with a history of left pneumonectomy for pulmonary abscess and Swyer-James syndrome who developed a life-threatening complication during arthroscopic rotator cuff repair performed under general anesthesia in the left lateral decubitus position. Intraoperatively, the patient developed cardiac arrest with pulseless ventricular tachycardia (VT). Return of spontaneous circulation (ROSC) was achieved through cardiopulmonary resuscitation, after which evaluation revealed tension pneumothorax. The pneumothorax was managed with chest tube insertion and intensive monitoring.

This case illustrates that even low-risk procedures, such as arthroscopic shoulder surgery, can lead to life-threatening complications including tension pneumothorax and cardiac arrest with pulseless VT in patients with significant pulmonary comorbidities. Clinicians must maintain a high index of suspicion for tension pneumothorax.

When multiple risk factors-such as prior pneumonectomy, single-lung physiology, lateral decubitus positioning, and mechanical ventilation-are present concurrently, thorough preoperative assessment, individualized ventilatory strategies, and proactive intraoperative planning are essential to prevent fatal outcomes.