A Case Of Ventilatory Disorder Due To Subcutaneous Emphysema After Elevated EtCO₂ During Total Laparoscopic Hysterectomy

Abstract

The patient was a 44-year-old woman (gravida 0, para 0). We performed a total laparoscopic hysterectomy for hypermenorrhea due to submucous leiomyoma. Pneumoperitoneum was created by using 10 mmHg CO 2 . It was difficult to insert the trocar at the right lower abdominal point. End-tidal carbon dioxide (EtCO 2 ) increased gradually and was at 60 mmHg an hour after pneumoperitoneum was created. Upon investigation, a broad emphysema from the right lower jaw to the right femur was observed. This might be due to the inappropriate trocar insertion. We increased the frequency of ventilation throughout the procedure. The procedure lasted for two hours and two minutes. The emphysema improved from the right chest to the right lower abdomen at the third postoperative day and diminished at the fourth postoperative day. She was discharged at the seventh postoperative day. There are a few reports of severe ventilatory disorders because of subcutaneous emphysema due to laparoscopic surgery. Although subcutaneous emphysema often disappears spontaneously, transition to open surgery and intubation after surgery were needed in some cases. Although there is no obvious management of subcutaneous emphysema, transition to open surgery should be considered in case where EtCO 2 is increased even if we increased the frequency of ventilation.