Ishikawa Seiji, Shirakawa Kaori, Kuroda Yui, Yube Yukinori, Mine Shinji, Hayashida Masakazu, Kawagoe Izumi
Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Juntendo University, 2-1-1, Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan.
Clinical Training Center, Juntendo University Hospital, 3-1-3, Hongo, Bunkyo-Ku, Tokyo, 113-8431, Japan.
JA Clin Rep. 2023 Jun 22;9(1):37. doi: 10.1186/s40981-023-00630-y.
Postoperative pneumothorax is a well-known but relatively rare complication after laparoscopic surgery. There has been no report describing pneumothorax that persisted for a week or more after laparoscopic surgery. Herein, we report a case of bilateral pneumothorax after laparoscopic surgery, which appears to have occurred by a different mechanism than previously described.
A 65-year-old male, with a past history of esophagectomy and retrosternal gastric tube reconstruction 4 months earlier, underwent a robotic-assisted inguinal hernia repair. Postoperative chest x-rays revealed the development of bilateral pneumothorax, which became worse on postoperative day (POD) 1 and took more than 9 days to resolve spontaneously. We assumed that intra-abdominal gas replaced by the air after pneumoperitoneum might have migrated into thoracic cavities through an opened esophageal hiatus or along the retrosternal route.
Laparoscopic surgery after radical esophagectomy may be associated with an increased risk of postoperative pneumothorax.
术后气胸是腹腔镜手术后一种广为人知但相对罕见的并发症。目前尚无关于腹腔镜手术后气胸持续一周或更长时间的报道。在此，我们报告一例腹腔镜手术后双侧气胸病例，其发生机制似乎与先前描述的不同。
一名65岁男性，4个月前曾接受食管切除术及胸骨后胃管重建术，接受了机器人辅助腹股沟疝修补术。术后胸部X线检查显示双侧气胸形成，术后第1天病情加重，自发缓解超过9天。我们推测气腹后腹腔内被空气取代的气体可能通过开放的食管裂孔或沿胸骨后途径进入胸腔。
根治性食管切除术后的腹腔镜手术可能增加术后气胸的风险。
