[Capnothorax and subcutaneous emphysema in attempted laparoscopic suture of duodenal ulcer]

A 72-year old lady suffering from coronary heart disease was admitted with acute abdominal pain. Laparoscopy was performed and revealed perforation of a duodenal ulcer. The surgeon decided to suture the perforation via laparoscope. After an uncomplicated start he had to finish the laparoscopic procedure because of a massive hypercapnia and a developing subcutaneous emphysema. Laparotomy showed an iatrogenic perforation of the right diaphragm. A chest drain was inserted; after suturing of the perforated ulcer the abdomen was closed. The further hospital stay was uneventful. The possible causes for the increasing hypercapnia are discussed. We suggest close monitoring of patients during laparoscopy including capnometry and the anaesthesist should be aware of rare complications.