Spontaneous Resolution of Massive Right-Sided Pneumothorax Occurring During Laparoscopic Cholecystectomy

Abstract

Pneumothorax is a rare but potentially serious complication that can occur during laparoscopic surgery. We describe a case of a spontaneous massive right-sided pneumothorax that occurred during laparoscopic cholecystectomy, presumably because of escape of intraperitoneal carbon dioxide under pressure into the pleural cavity through a congenital defect in the diaphragm. During the procedure, arterial oxygen saturation decreased and clinical examination revealed signs of a right-sided pneumothorax. This was confirmed on chest x-ray in the immediate postoperative period. Since the patient was clinically stable without any signs of respiratory distress, a conservative approach was adopted. The patient remained on close clinical observation and continuous monitoring of arterial hemoglobin oxygen saturation by pulse oximetry and repeat chest x-rays and had an uneventful recovery with complete resolution of the pneumothorax 3 hours after surgery and without the need for thoracic aspiration or tube thoracostomy.

Anesthesia considerations for robotic surgery in gynecologic oncology

“…Pneumothorax, pneumomediastinum, and pneumopericardium have been described with laparoscopic surgery and are more likely to occur in patients with diaphragmatic defects and reverse Trendelenburg (e.g. Bochdalek and Morgagni hernias) [8,9]. These complications are rare and are usually self-limiting with no adverse hemodynamic consequences.…”

Spontaneous Resolution of Massive Spontaneous Tubercular Pneumothorax

“…There are published case reports on spontaneous resolution of traumatic pneumothorax with conservative management [3, 4]. Here we present one that may be the first case of spontaneous resolution of massive pneumothorax secondary to tuberculosis.…”

Carbon dioxide pneumothorax occurring during laparoscopy-assisted gastrectomy due to a congenital diaphragmatic defect: a case report

“…The iatrogenic causes are multiple including rupture of emphysematous bullae or bleb due to barotrauma, direct injury to the diaphragm during dissection, central line placement or even trocar sites. During CO 2 pneumoperitoneum, pneumothorax may also be caused by congenital defects in the diaphragm or other defects around sites where the aorta, vena cava, and esophagus traverse the diaphragm [ 1 2 ].…”

“…Although pneumothorax can occur at any time during laparoscopic surgery, a specific type of pneumothorax occurs subsequent to carbon dioxide (CO 2 ) pneumoperitoneum creation. This CO 2 pneumothorax, although rare, is caused by escape of the intraperitoneal CO 2 gas, under pressure, into the pleural cavity through a congenital defect in the diaphragm [ 1 2 ].…”

“…In cases of major pneumothorax, due to underlying lung diseases, immediate simple aspiration or chest tube drainage is generally recommended [ 3 ]. However, most cases of CO 2 pneumothorax, although large, can be managed successfully by conservative treatments unless it does not have a tension physiology or there is severe hemodynamic compromise [ 2 4 5 6 ]. This may be due to the high solubility of CO 2 gas (therefore, rapid resolution after release of the pneumoperitoneum) and the extra-pulmonary mechanism (therefore, no damage to the lung parenchyma) [ 4 ].…”