Unilateral Periorbital and Cervical Subcutaneous Emphysema Following Extraperitoneal Laparoscopic Radical Prostatectomy

Abstract

A patient undergoing laparoscopic radical prostatectomy developed unilateral periorbital edema and cervical subcutaneous emphysema following carbon dioxide insufflation into the retropubic and retroperitoneal space. He had hypercarbia and acidosis during and after the end of the case and he required hyperventilation in the recovery room for two hours before the hypercarbia subsided and the arterial blood gases returned to normal levels. Despite massive surgical emphysema reaching up to his face, there was no evidence of a pneumothorax or pneumomediastinum in this patient. He had no respiratory distress and his visual examination was normal and the periorbital surgical emphysema subsided gradually within two days. The management of this complication and a review of the literature is presented.

Extensive Subcutaneous Emphysema after Laparoscopic Cholecystectomy, Two Cases Reports

“…A latent pocket of carbon dioxide in the abdominal wall which disseminated only later, after mobilization of the patient; a gas leak from the anastomosis, later resealed; a small iatrogenic mucosal disruption, resulting in retroperitoneal air leak, settled spontaneously may also explain its development. On the other hand, an iatrogenic airway injury or a pneumothorax appears unlikely because of clinical and radiological findings [17].…”

“…The original peritoneal penetration site, then mechanically extended allowing gas extravasation into planes outside of the abdomen [4]. Anatomical connection between the cervical fascia and retro-peritoneum was documented [17]. Notably, the soft tissues of the neck are divided into three main compartments by layers of cervical fascia.…”

“…Two of these three spaces terminate at the upper thoracic spine; the visceral space, however, descends further, investing the trachea and esophagus from the neck into the chest. Inferiorly, the visceral space extends with the esophagus through the diaphragmatic hiatus into the retroperitoneal soft tissues [17]. Murdock notes an established link between preperitoneal insufflation and extensive dissection of retroperitoneal air [17].…”

“…Inferiorly, the visceral space extends with the esophagus through the diaphragmatic hiatus into the retroperitoneal soft tissues [17]. Murdock notes an established link between preperitoneal insufflation and extensive dissection of retroperitoneal air [17]. Hypercarbia stimulates sympathetic nervous system, and hence the BP and HR increased.…”

Colonic perforation during laparoscopic hernia repair presented as delayed generalized subcutaneous emphysema: a clue to intra-abdominal complication

“…10 Usually, abdominal wall layers, muscles and skin, acts as seal around the trocars, preventing leakage, in conditions where the seal is loose, such as below arcuate line inserted trocars, or the presence of thick subcutaneous tissue all can predispose for the development of subcutaneous emphysema. 4 There is an anatomical connection between the cervical fascia of the neck and retroperitoneum. The investing layer covering trachea and esophagus extend from the neck inferiorly through the hiatus in to the retroperitoneal space.…”