Capnothorax During Laparoscopy in Trendelenburg Position: A Rare Case Study

Ana Margarida Damas, Fátima Gonçalves, Marisa Antunes, Sónia Barata

Abstract


Pneumothorax is an infrequent complication of laparoscopic surgery. Most cases occur during upper abdominal surgery, since a head-down position (Trendelenburg) pushes the liver and peritoneum against the diaphragm, reducing gas release. When it is due to CO2 diffusion across congenital diaphragmatic defects, it usually resolves itself spontaneously after de-insufflation of the pneumoperitoneum. Increasing positive end-expiratory pressure to counteract intra-abdominal pressure is an effective measure when a pulmonary origin is excluded. We report a case of right-sided hypertensive capnothorax due to a diaphragmatic defect, during lower abdominal surgery, which was successfully managed without the need for chest drainage. This case highlights the importance of maintaining active vigilance and a high index of suspicion for pneumothorax during laparoscopic surgery. 


Keywords


Head-Down Tilt/adverse effects; Laparoscopy; Pneumothorax/etiology; Positive-Pressure Respiration

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