Pneumopericardium associated with laparoscopy

doi:10.1016/0952-8180(91)90208-5

Journal of Clinical Anesthesia

Volume 3, Issue 1, January–February 1991, Pages 56-59

https://doi.org/10.1016/0952-8180(91)90208-5 Get rights and content

Abstract

This case report describes a rare but potentially serious complication of pneumopericardium occurring during diagnostic laparoscopy. Contributing factors and possible etiologies are discussed.

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2006, EAU-EBU Update Series
We provide urologists with an overview of the anaesthetic consequences of the physiological changes which occur during laparoscopic surgery. An understanding of these issues is important as increased awareness by surgeons of potential problems will improve communication and understanding within the surgical team and thus help to improve patient safety.
The article considers the physiological effects of pneumoperitoneum, patient position, and gas absorption as well as anaesthetic management of the changes which occur.
Laparoscopic surgery offers many advantages for the patient requiring surgical treatment of urinary tract disease and the potential metabolic changes which can occur as a result are far outweighed by the shortened hospital stay and recovery time which result from use of this surgical approach.
Thoracic complications during urological laparoscopy
2004, Journal of Urology
We documented thoracic related complications during urological laparoscopic surgery.
A total of 1,129 patients underwent major urological laparoscopic procedures in a 5-year period. Operative reports and postoperative radiographic reports were retrospectively reviewed to identify patients with thoracic related medical and surgical sequelae. Of the patients 619 (55%) underwent at least 1 chest x-ray in the immediate or early postoperative period. In the remaining 510 patients (45%) there was no clinical indication to perform chest x-ray.
Of 619 patients undergoing chest x-ray 438 (71%) were completely normal. Medical pulmonary complications, surgical thoracic complications and subclinical, incidentally detected gas collections in the chest were identified in 12.6%, 0.5% and 5.5% of patients, respectively. Medical complications in 12.6% of cases included pulmonary infiltrate/atelectasis in 9.7%, pleural effusion in 4.8% and pulmonary embolus in 0.3%. Surgical complications included symptomatic pneumothorax in 4 patients (0.35%), hemothorax in 1 (0.08%) and chylothorax in 1 (0.08%). Subclinical abnormal thoracic gas collections were radiographically noted in 34 of the 619 patients (5.5%) on chest x-ray, including pneumomediastinum in 19 (3.1%), pneumothorax in 10 (1.6%) and pneumopericardium in 5 (0.8%). Overall 36 of 40 (90%) thoracic surgical complications (3) and subclinical, incidentally detected gas collections (33) occurred during retroperitoneal laparoscopy. Re-intervention was necessary in 6 patients (0.5%), namely pulmonary embolus requiring vena caval filter placement in 3 (0.3%), pneumothorax requiring a chest tube in 2 (0.17%) and hemothorax requiring emergency open thoracotomy in 1 (0.08%). No patient underwent open conversion to complete the initial proposed operation.
Due to its high solubility the expectant management of incidental CO₂ pneumothorax, pneumopericardium and pneumomediastinum is recommended initially in the clinically stable patient. Inadvertent diaphragmatic entry can be satisfactorily repaired laparoscopically without open conversion. Although it is rare, surgical thoracic complications are potentially life threatening, requiring prompt identification and management.
Complications of laparoscopy
2001, Anesthesiology Clinics of North America
Citation Excerpt :
Because CO2 is rapidly absorbed, there is probably no need for intercostal drainage as long as the situation resolves on release of the pneumoperitoneum; however, patients with significant cardiopulmonary impairment could require immediate placement of a chest tube.35 There also have been reports of pneumomediastinum and pneumopericardium during laparoscopy.47,58,68 It is proposed that the mechanisms of pneumomediastinum are similar to that of pneumothorax.
The advantages of the laparoscopic approach for surgical procedures include reduced postoperative pain, shorter hospital stays, rapid return to normal activities, and significant cost savings. This has led to performing more extensive procedures in older and sicker patients with significant coexisting cardiopulmonary disease. However, these procedures present new potentially life-threatening complications that are usually not seen with the traditional “open” approach. It therefore is important that the benefits of laparoscopic procedures are weighed against potential complications. Awareness of these potential complications and knowledge of their management should prevent mortality and reduce morbidity, thus improving patient care and safety.10, 24, 27, 52, 70, 78
The complications unique to laparoscopic surgery include those related to creation of pneumoperitoneum, patient positioning, and surgical instrumentation. Intraperitoneal carbon dioxide (CO₂) insufflation and changes in patient positioning during laparoscopic surgery have several hemodynamic, pulmonary, and endocrine consequences. In addition, several surgical complications, including subcutaneous emphysema, pneumothorax, pneumomediastinum, gas embolization, acute hemorrhage, and bowel or bladder perforation, can occur during the laparoscopic procedure. Postoperative complications include pain, nausea, vomiting, pulmonary impairment, wound infection, peritonitis, delayed hemorrhage, incisional hernia, and metastases at the trocar insertion sites. The hemodynamic and pulmonary changes during laparoscopy are discussed in the article by O'Malley and Cunningham, whereas postoperative pain, nausea, and vomiting are discussed by Smith. This article emphasizes the complications associated with surgical instrumentation.
Laparoscopic surgery and its potential for medical complications
1997, Heart and Lung: Journal of Acute and Critical Care
Laparoscopic surgery is very popular among physicians and patients because this technique is associated with safety, shorter hospital stay, early return to normal activity, and cosmetic acceptance of the operative scar. Although the procedure involves minimal invasion and tissue damage, it has potentially serious complications, including cardiopulmonary effects that result mainly from hypercarbia and raised intraabdominal pressure caused by pneumoperitoneum. Absorbed carbon dioxide from the peritoneal cavity tends to cause acidosis. Leakage of the gas into tissue spaces may induce subcutaneous emphysema, pneumothorax, pneumomediastinum and pneumopericardium. Cardiac effects include arrhythmias, hypotension, cardiac arrest, gas embolism, pulmonary edema, and myocardial ischemia or infarction. Some of these effects, though rare, are serious and potentially fatal. Physicians should anticipate these problems in their patients undergoing laparoscopic procedures. This review discusses the technique of and physiologic considerations in laparoscopic surgery as well as its potential complications. (Heart Lung® 1997; 26: 52–67.)
Laparoscopic fundoplication: A New technique with new complications?
1994, Journal of Clinical Anesthesia
Pneumopericardium without subcutaneous emphysema, pneumomediastinum, or pneumothorax after laparoscopy
1993, Gastrointestinal Endoscopy

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^∗: Assistant Professor of Anesthesia, Division of Ambulatory Surgery, Department of Anesthesiology

^†: Associate Professor of Anesthesia, Division of Ambulatory Surgery, Department of Anesthesiology

View full text

Case reportPneumopericardium associated with laparoscopy

Abstract

Fertil Steril

Bilateral pneumothorax associated with laparoscopy

Anaesthesia

Pneumopericardium following laparoscopy

Chest

An unusual complication of laparoscopy: pneumopericardium

Endoscopy

Anesthesia for laparoscopy: considerations, complications and techniques

J Reprod Med

Anesthesia risk

Laparoscopy: diagnostic experience in 300 patient studies

Am J Gastroenterol

Case report
Pneumopericardium associated with laparoscopy