Massive Subcutaneous Emphysema During Laparoscopic Gynecologic Surgery

Abstract

Massive subcutaneous emphysema is a rare complication in laparoscopic surgery. Complications such as insufflation, pneumothorax, pneumomediastinum to the preperitoneal area during pneumoperitoneum have also been reported in laparoscopic surgery. A 32-year-old, Body Mass Index (BMI) 26.2 kg/m2, woman was admitted for laparoscopic cystectomy because of right ovarian cyst. The end-tidal carbon dioxide values of the patient started to increase (end-tidalCO2:49mmHg) 20 minutes after starting CO2 insufflation (P:15mmHg). Subcutaneous emphysema was detected in face and neck, eyelids and PaCO2 was measured 59mmHg. Patient was extubated after positive pressure ventilation. Emphysemia in the face area including the eyelid continued in the 12th hour of the patient's emphysema completely regressed. Prolonged surgery, CO2 gas insufflation pressure ≥15mmHg, 6 or more trocar access, older age may reduce subcutaneous resistance and causes emphysema. In this case, we would like to highlight to massive subcutaneous emphysema in laparoscopic surgeries.

Keywords

• Gynecologic,Laparoscopic,Subcutaneous Emphysema

Jinekolojik Laparoskopik Cerrahi Sırasında Masif Cilt Altı Amfizem

Öz

Masif deri altı amfizemi laparoskopik cerrahide nadir görülen bir komplikasyondur. Laparoskopik cerrahide, pnömoperitonum sırasında insüflasyon, pnömotoraks, pnömomediastinumun pnömoperitonum sırasında preperitoneal alana kadar olan komplikasyonlar bildirilmiştir. Otuz iki yaşında, Vücut Kitle İndeksi (VKİ) 26.2 kg/m2 olan kadın hastaya sağ over kisti nedeniyle laparoskopik kistektomi yapıldı. Hastanın son tidal karbondioksit (CO2) değerleri (ETC02: 49 mmHg), CO2 insüflasyonuna (P: 15 mmHg) başladıktan 20 dakika sonra artmaya başladı. Yüz, göz kapakları ve boyunda subkutan amfizem tespit edildi, PaCO2 59 mmHg olarak ölçüldü. Pozitif basınçlı ventilasyondan sonra hasta ekstübe edildi. Göz kapağı da dahil olmak üzere yüz bölgesindeki amfizemi, hastada amfizem tespit edildikten 12 saat sonra tamamen geriledi. Uzun süren laparoskopik cerrahiler, CO2 gazı basıncının ≥15mmHg olması, 6 veya daha fazla trokar girişinin varlığı ve artan yaşla beraber ciltaltı direnci azalır ve amfizeme sebep olur. Bu olguda, laparoskopik cerrahilerde masif ciltaltı amfizemin oluşabileceğini vurgulamak istedik.

Anahtar Kelimeler

• Jinekolojik,laparoskopik,subkutan amfizem

Kaynakça

1. 1. Whiteman MK, Hillis SD, Jamieson DJ, et al. Inpatient hysterectomy surveillance in the United States, 2000–2004. Am J Obstet Gynecol. 2008;198:34.1-7.
2. 2. Fuentes MN, Rodríguez-Oliver A, Naveiro Rilo JC, et al. Complications of laparoscopic gynecologic surgery. JSLS. 2014;18 (3):e2014.00058. doi:10.4293/ JSLS.2014.00058
3. 3. Baron PW, Ben-Youssef R, Ojogho ON, et al. Morbidity of 200 consecutive cases of handassisted laparoscopic living donor nephrectomies: A single-center experience. J Transplant. 2012;2012:121523. doi:10.1155/2012/121523
4. 4. Murdock CM, Wolff AJ, Geem TV. Risk factors for hyper- carbia, subcutaneous emphysema, pneumothorax and pneumomediastinum during laparoscopy. Obstet Gynecol. 2000;95(5):704– 9.
5. 5. Worrel J, Cleary D. Massive subcutaneous emphysema and hyprcarbia: complications of CO2 absorption during extraperitoneal and intraperitoneal laparoscopic surgery – case studies. AANA J. 2002;70:456–461.
6. 6. Sumpf E, Crozier A, Ahrens D, et al. Carbon dioxide absorption during extra peritoneal and trans peritoneal endoscopic hernioplasty. Anesth Analg. 2000;91:589-95.
7. 7. Klopfenstein CE, Gaggero G, Mamie C, et al. Laparoscopic extraperitoneal inguinal hernia repair complicated by subcutaneous emphysema. Can J Anaesth. 1995;42:523–25.
8. 8. Yagihashi Y, Okinami T, Fukuzawa S. Case of pharyngeal emphysema with airway obstruction during retroperitoneal laparoscopic nephroureterectomy. Nihon Hinyokika Gakkai Zasshi. 2009;100:540–544.

9. 9. Suresh YV., Suresh YA, Sequeira TF. Laparoscopy-Pneumothorax and Ocular Emphysema, A Rare Complication-A Case Report. Journal of Clinical and Diagnostic Research. 2014;8:1-2.
10. 10. Yu T, Cheng Y, Wang X, et al. Gases for establishing pneumoperitoneum during laparoscopic abdominal surgery. Cochrane Database of Systematic Reviews. 2017;6:CD009569.