2024 FSA Podium and Poster Abstracts
P079: A CASE OF IATROGENIC BILATERAL PNEUMOTHORAX AFTER PROLONGED LAPAROSCOPIC HYSTERECTOMY
Jackeline Porto, MD1; Jessica Alonso, MD1; Harshvardhan Rajen1; Oleg Desyatnikov, DO1; Ryan Shienbaum, MD2; Michael Decker, MD2; 1HCA Florida Kendall Hospital; 2HCA Florida Aventura Hospital
Our patient is a 51 year old female with a past medical history of hypertension and hyperlipidemia who presented for outpatient elective hysterectomy secondary to fibroids and menorrhagia. The planned surgical procedure was a robotic assisted total hysterectomy and bilateral salpingectomy. The patient underwent general anesthesia with standard monitoring equipment and uneventful induction with sedative, analgesic, and paralytic medications prior to securing the airway with an endotracheal tube. Maintenance of anesthesia was achieved with volatile anesthetic gas. As part of the procedure, the patient was placed in steep trendelenburg to facilitate surgical field of view and exposure of the uterus. The total time of the procedure was just under 5 hours.
At the completion of the surgery, and the drapes were removed, a large amount of subcutaneous emphysema was noted to be covering much of the patient's abdomen and chest. After extubation criteria were met and the patient extubated, she was placed on non rebreather mask to receive oxygen and transported to the post anesthesia care unit. A plain radiograph of the chest in the recovery unit demonstrated the presence of bilateral small pneumothoraces in the lung apices. There was no tension physiology noted at this time. The patient was maintained on supplemental oxygen and admitted to the post surgical floor for observation overnight. The following day, the majority of the subcutaneous emphysema had resolved, and repeated chest radiograph demonstrated resolution of both pneumothoraces. The patient was then discharged home.
This type of complication is relatively rare to occur with pelvic or abdominal laparoscopic surgeries. Luckily in this case, the patient required only observation and supplemental oxygen. However, the possibility exists for more serious and life threatening complications from pneumothorax to develop such as requiring a thoracostomy tube to be inserted into the pleural space. The possibility exists for hemodynamic instability if tension pneumothorax physiology were to develop. Patients undergoing ambulatory outpatient procedures should be monitored to ensure there are no potential life threatening sequelae if the patient were to be discharged home. Anesthesiologists should be aware that this type of complication from surgeries with prolonged insufflation of the abdominal and pelvic cavities may cause tracking of subcutaneous emphysema, sometimes up the head and face.