title: Nitrogenous subcutaneous emphysema caused by spray application of fibrin glue during retroperitoneal laparoscopic surgery.
abstract: We report a case of a patient treated by retroperitoneoscopic partial nephrectomy who developed nitrogenous subcutaneous emphysema (SCE) as a complication. The use of a nitrogen gas-pressured fibrin tissue adhesive applied as a spray caused excessively increased pressure in the closed retroperitoneal space and resulted in widespread SCE with protracted clinical course. To the best of our knowledge, this is the first report of nitrogenous SCE associated with pneumoperitoneum. The clinical significance of nitrogenous SCE is emphasized, and the risks associated with the use of fibrin glue as a spray during laparoscopic surgery are discussed.
authors.affiliation: Department of Anesthesia, Kasukabe-chuo General Hospital, Midori-cho 5-9-4, Kasukabe, Saitama, 344-0063, Japan. shinjimat@hotmail.com
authors.forename: Shinji
authors.initials: S
authors.lastname: Matsuse
authors.forename: Atsushi
authors.initials: A
authors.lastname: Maruyama
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Hara
mesh_terms: D000335:Aerosol Propellants / Q000009:adverse effects*; D000336:Aerosols; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D007668:Kidney / Q000601:surgery; D007680:Kidney Neoplasms / Q000601:surgery; D010535:Laparoscopy; D008875:Middle Aged; D009584:Nitrogen / Q000009:adverse effects*; D011027:Pneumoperitoneum / Q000000981:diagnostic imaging / Q000209:etiology; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000628:therapy; D013902:Radiography, Thoracic; D012187:Retroperitoneal Space / Q000000981:diagnostic imaging / Q000601:surgery*; D013352:Subcutaneous Emphysema / Q000139:chemically induced* / Q000000981:diagnostic imaging; D014014:Tissue Adhesives / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D000335:Aerosol Propellants; D000336:Aerosols; D015718:Fibrin Tissue Adhesive; D014014:Tissue Adhesives; D009584:Nitrogen