Abstract
Pneumomediastinum is defined as the presence of air in mediastinum. This clinical entity is mostly seen due to sudden increase in pressure within the alveoli and rupture of the alveoli. Laparoscopic cholecystectomy was performed in a 26 years old women who suffered from gallstone cholecystitis. In the early postoperative period swelling at the neck and face were observed and subcutaneus emphysema and pneumomediastinum were diagnosed. In broncoscopy, superficial laceration of the tracheal mucosa was observed at the posterior wall. The patient was clinically well and taken under close observation and medical treatment with antibiotics (cephazolin 500 mg 2x1, iv), nasal oxygen and antitussive (pentoxyverin 1.5 mg/ml 3x1, p.o), restriction of activity, avoiding any increase in the intraabdominal pressure and coughing. No complication was observed during the follow-up period and the patient was discharged from the hospital postoperative on the fifth day. Controls of the patient were normal on 1 week and 1 month after discharge. This case is presented due to its rarity and literature is reviewed.
Keywords:
Pneumomediastinum, subcutaneous emphysema, laparoscopic surgery
References
1Hamman L. Spontaneous mediastinal emphysema. Bull Johns Hopkins Hosp 1939; 64; 1- 21.
2Lopez MF, Roldan JS. Cervical emphysema, pneumomediastinum, and pneumothorax following selfinduced oral injury. Chest 2001;120:306-309.
3Raley JC, Andrews JI. Spontaneous pneumomediastinum presenting as jaw pain during labor. Obstet Gynecol 2001;98:904- 906.
4Joris J, Ledoux D, Honore P, Lamy M: Ventilatory effects of CO2 insuflation during laparoscopic cholecystectomy. Anesthesiology (suppl 3) 1991; 75.121-125. DOI:10.1097/00000542-199109001-00121
5Saper NJ, Stockman PT, Dumegan DL. Laparoscopic cholecyctectomy. Arch Surg 1992; 127: 917-921.
6Whiston RJ, Eggers KA, Morris RW, et al. Tension pneumothorax during laparoscopic cholesyctectomy. Br J Surg 1991;78:1325.
7Knos GB, Sung YF, Toledo A: Pneumopericardium associated with laparoscopy. J Clin Anesth 1991;3:56. 8 . McConell MS, Finn JC, Feeley TW: Tension hydrotorax during laparoscopy in a patient with ascites. Anesthesiology 1994; 80:1390.
8Crouch R D, Nelson LE, Hawley PC, et al. Onlay patch repair of tracheobronchial rupture. Ann Thorac Surg 1997;64:1158- 1160.
9Carbognani P, Bobbio A, Catteleni L, et al. Management of postintubation membranous tracheal rupture. Ann Thorac Surg 2004;77:406-409.
10Conti M, Pougeoise M, Wurtz A, et al. Management of postintubation tracheobronchial ruptures. Chest 2006; 130:412-
11DOI:10.1378/chest.130.2.412
12Genç O, Balkanlı K. Trakeobronşiyal yaralanmalar. Yüksel M, Çetin G, editörler. Toraks Travmaları. İstanbul: Turgut Yayıncılık, 2003;105-120.
13Chen EH, Logman ZM, Glass PS, Bilfinger TV. A case of tracheal injury after emergent endotracheal intubation: A review of the literature and causalities. Anesth Analg 2001;93:1270-1271.
14Lampl L. Tracheobronchial injuries. Conservative treatment. Interact Cardiovasc Thorac Surg 2004;3:401-405.
15Schneider T, Storz K, Dienemann H, Hoffmann H. Management of iatrogenic tracheobronchial injuries: A retrospective analysis of 29 cases. Ann Thorac Surg 2007;83:1960-1964.
16Hofmann HS, Rettig G, Radke J, et al. Iatrogenic ruptures of the tracheobronchial tree. Eur J Cardiothorac Surg 2002;21:649-652.
17Jougon J, Ballester, M, Choukroun E, et al. Conservative treatment for postintubation tracheobronchial rupture. Ann Thorac Surg 2000;69:216-220.
18Işık AF, Kurnaz M, Çobanoğlu U. Göz travması sonrası gelişen pnömomediastinum. Türk Göğüs Kalp Damar Cer Derg 2005; 13; 177-178.
19Ralp-Edwards AC, Pearson FG. Atypical presentation of spontaneous pneumomediastinum. Ann Thorac Surg 1994; 58; 1758-1760.