Ngo Trung Kien, Le Duy Binh, Bui Hoang Thao, Pham Van Khiet
Department of Urology, Saint Paul Hospital, Hanoi, Viet Nam.
Department of Urology, Saint Paul Hospital, Hanoi, Viet Nam.
Int J Surg Case Rep. 2021 Feb;79:299-301. doi: 10.1016/j.ijscr.2021.01.059. Epub 2021 Jan 18.
Pneumopericardium is collection of gas in pericardial space. Retrospective reviews have described pneumopericardium as a complication of laparoscopic surgery, however, without any symptoms. By this report, we present a case who developed acute cardiopulmonary symptoms after retroperitoneal laparoscopic radical nephrectomy because of pneumopericardium.
A 40-year-old Vietnamese woman was admitted due to left flank pain. She was diagnosed with left dysfunctional hydronephrosis and right urolithiasis. Six hours post-operation of an elective retroperitoneal laparoscopic radical nephrectomy, she suddenly developed severe substernal chest pain and dyspnea. Evaluations for acute myocardial infarction and pulmonary embolism were immediately ordered with no abnormality. However, computed tomography scan of the chest showed pneumopericardium, pneumomediastinum, subcutaneous emphysema, gas collection in sub-peritoneal space and next to the aortic arch. She was then closely monitored and effectively managed by conservative treatments.
Pneumopericardium is a rare complication of laparoscopy and mainly detected by radiographical measures incidentally. Several case studies reported symptomatic pneumopericardium, as in our presenting case. Some factors might contribute to the mechanism of our case that include retroperitoneal approach, thoroughly dissection the renal helium area and long-lasting operation. Post-operative collection of carbon dioxide is well self-limited; therefore, conservative treatments are efficient for stable cases.
Pneumopericardium following laparoscopy is uncommon, and mostly subclinical. However, it can manifest as acute cardiopulmonary symptoms and signs that require carefully evaluation. The presence of gas in pericardial space is a negative prognosis factor itself; consequently, clinicians should be aware of when managing pneumopericardium subsequent to laparoscopic procedures.
心包积气是指气体积聚于心包腔内。回顾性研究曾将心包积气描述为腹腔镜手术的一种并发症，然而，患者并无任何症状。通过本报告，我们呈现一例因心包积气在腹膜后腹腔镜根治性肾切除术后出现急性心肺症状的病例。
一名40岁的越南女性因左侧腰痛入院。她被诊断为左侧功能性肾积水和右侧尿路结石。在择期腹膜后腹腔镜根治性肾切除术后6小时，她突然出现严重的胸骨后胸痛和呼吸困难。立即安排了针对急性心肌梗死和肺栓塞的评估，结果均无异常。然而，胸部计算机断层扫描显示有心包积气、纵隔积气、皮下气肿、腹膜下间隙及主动脉弓旁气体积聚。随后对她进行了密切监测，并通过保守治疗进行有效管理。
心包积气是腹腔镜手术的一种罕见并发症，主要通过影像学检查偶然发现。正如我们所呈现的病例一样，有几例病例研究报告了有症状的心包积气。一些因素可能导致了我们这个病例的发生机制，包括腹膜后入路、对肾周区域的彻底解剖以及手术时间过长。术后二氧化碳的积聚具有良好的自限性；因此，对于病情稳定的病例，保守治疗是有效的。
腹腔镜术后心包积气并不常见，且大多为亚临床状态。然而，它可表现为急性心肺症状和体征，需要仔细评估。心包腔内存在气体本身就是一个不良预后因素；因此，临床医生在处理腹腔镜手术后的心包积气时应予以注意。
