title: Gas extravasation complicating laparoscopic extraperitoneal inguinal hernia repair.
abstract: Carbon dioxide can extravasate from the abdominal cavity during insufflation and result in pneumomediastinum, pneumothorax, and subcutaneous emphysema. We report a case of unilateral pneumothorax with pneumomediastinum and subcutaneous emphysema after laparoscopic extraperitoneal bilateral inguinal hernia repair. Additionally, we discuss the pathophysiology, diagnostic work-up, and management of this malady. Because of the natural resolution of CO2 pneumothoraces, observation for asymptomatic patients is appropriate, whereas tube thoracostomy should be reserved for symptomatic patients. It is utmost importance to determine the etiology of gas extravastion and consider other complications such as airway or esophageal injury or pulmonary barotrauma.
authors.affiliation: Institute for Minimally Invasive Surgery, St. Agnes Hospital, 303 North Street, Suite #103, White Plains, NY 10605, USA.
authors.forename: E J
authors.initials: EJ
authors.lastname: Hagopian
authors.forename: F M
authors.initials: FM
authors.lastname: Steichen
authors.forename: K F
authors.initials: KF
authors.lastname: Lee
authors.forename: D B
authors.initials: DB
authors.lastname: Earle
mesh_terms: D000005:Abdomen; D000328:Adult; D002245:Carbon Dioxide / Q000008:administration & dosage; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000150:complications*; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D007327:Insufflation / Q000009:adverse effects / Q000379:methods; D007431:Intraoperative Complications / Q000175:diagnosis; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods*; D008297:Male; D008478:Mediastinal Emphysema / Q000175:diagnosis; D011027:Pneumoperitoneum / Q000175:diagnosis / Q000209:etiology*; D013352:Subcutaneous Emphysema / Q000175:diagnosis / Q000209:etiology*
chemical_list: D002245:Carbon Dioxide