Koliakos Nikolaos, Papaconstantinou Dimitrios, Tzortzis Andrianos-Serafeim, Schizas Dimitrios, Bistarakis Dimitrios, Bakopoulos Anargyros
3rd Department of Surgery, Medical School, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece.
1st Department of Surgery, Medical School, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece.
J Minim Access Surg. 2021 Jul-Sep;17(3):385-388. doi: 10.4103/jmas.JMAS_34_21.
Totally extra-peritoneal (TEP) and trans-abdominal pre-peritoneal repair are the two most commonly performed types of laparoscopic hernia repair procedures. Herein, we present a rare case of pneumothorax and pneumomediastinum that ensued during a TEP inguinal hernia repair. A 73-year-old man presented for elective laparoscopic right-sided hernia repair. After intubation, a 10-mm and two 5-mm trocars were placed in the peri-umbilical and midline area, respectively. A balloon dissector was inserted from the 10-mm trocar to develop the retro-rectus space and carbon dioxide was insufflated up to a pressure of 14 mmHg. About 55 min after insufflation, the patient presented subcutaneous emphysema, oxygen saturation dropped from 100% to 96% and pCO increased to 55 mmHg. Due to concerns for pulmonary embolism, he immediately underwent a chest computed tomography, which revealed pneumothorax, pneumomediastinum and subcutaneous emphysema extended throughout the neck, thorax and upper abdomen. The patient was successfully treated conservatively with oral analgesia and supplemental oxygen and was discharged on the 4 post-operative day without any further complications.
完全腹膜外（TEP）修补术和经腹腹膜前修补术是两种最常用的腹腔镜疝修补手术方式。在此，我们报告1例在TEP腹股沟疝修补术中发生气胸和纵隔气肿的罕见病例。一名73岁男性因择期腹腔镜右侧疝修补术就诊。插管后，分别在脐周和中线区域置入一个10毫米和两个5毫米的套管针。从10毫米套管针插入球囊分离器以分离腹直肌后间隙，并注入二氧化碳，压力达到14毫米汞柱。注气约55分钟后，患者出现皮下气肿，氧饱和度从100%降至96%，二氧化碳分压升至55毫米汞柱。由于担心肺栓塞，他立即接受了胸部计算机断层扫描，结果显示气胸、纵隔气肿和皮下气肿蔓延至整个颈部、胸部和上腹部。该患者通过口服镇痛药和补充氧气成功接受保守治疗，并于术后第4天出院，无任何进一步并发症。
