Delayed surgical emphysema, pneumomediastinum and bilateral pneumothoraces after postoperative vomiting

We describe a case of surgical emphysema, pneumomediastinum and bilateral pneumothoraces which occurred some hours after general anaesthesia for a repeat laparoscopy and followed persistent nausea and vomiting. We report the case because of the unexpected and delayed appearance, which led to delay in diagnosis and management. We suggest that this intrathoracic air leak was a consequence of postoperative vomiting rather than a complication of laparoscopy.