Isolated pneumomediastinum following laparoscopic cholecystectomy: a rare complication

Abstract

Development of postoperative pneumomediastinum is one of the most infrequent complications of laparoscopic procedures. We report a case of a 47-year-old woman who developed pneumomediastinum consequently to laparoscopic cholecystectomy. The patient was treated conservatively and was discharged on the fifth postoperative day. Early detection of this condition, differential diagnosis and careful monitoring of the patient are important, as it may lead to severe consequences, including the life-threatening tension pneumomediastinum.

Pneumomediastinum and ECG changes during laparoscopic Nissen fundoplication in a child; Case report

“…However, routine chest x- ray can be utilized to monitor the resolution and tissue absorption of PM [ 6 , 12 ]. Despite the high solubility of CO 2 in blood, many studies had observed that extra abdominal gas could persist from 1 to 4 days after surgery till complete resolution, it is believed this might be due to the avascular nature of the areolar tissue of the mediastinum [ 6 , [13] , [14] , [15] ]. In our patient, the initial portable chest x-ray was suspicious for PM and the repeated x-ray in post-operative day 2 did not show any concern compared to the intra-operative one.…”

“…In adult literature, PM had been reported in some laparoscopic procedures such as cholecystectomy, hysterectomy and herniorraphy [ [13] , [14] , [15] , [16] ]. Other studies looked at the incidence and significance of PM after laparoscopic surgery related to esophagus and found that two thirds of their patients had developed PM that spontaneously resolved the next day.…”

“…The most common cause of PM is an increase in the alveolar pressure leading to rupture and leakage of air into the thoracic and/or mediastinal cavity. Other causes could be traumatic injury, esophageal perforation and barotrauma secondary to mechanical ventilation application [ [13] , [14] , [15] , [16] , 17 ]. In abdominal laparoscopic surgeries, it is more often to see pneumothorax and/or subcutaneous emphysema along with PM rather than isolated PM.…”

“…In abdominal laparoscopic surgeries, it is more often to see pneumothorax and/or subcutaneous emphysema along with PM rather than isolated PM. When it is isolated, it is believed to be due to the passage of air into the mediastinum through either the hiatus or a defect in the diaphragm [ 14 , 17 ]. Some studies have found independent risk factors that increase the possibility of having PM such as long operative time (more than 200 min) and Et CO 2 of 50 mmHg or greater.…”

Symptomatic Pneumomediastinum Following Laparoscopic Cholecystectomy: A Case Report and a Literature Review

“…The treatment of choice for symptomatic cholelithiasis has become laparoscopic cholecystectomy [ 1 ]. Laparoscopic surgeries have gained wide acceptance in our time due to the reduced morbidity and mortality, shorter hospital stay, better postoperative recovery, less postoperative pain, and reduced cost as compared to open surgeries [ 2 ].…”