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Symptomatic pneumopericardium - A rare complication following retroperitoneal laparoscopic nephrectomy: A case report.

Authors :
Ngo TK
Le DB
Bui HT
Pham VK
Source :
International journal of surgery case reports [Int J Surg Case Rep] 2021 Feb; Vol. 79, pp. 299-301. Date of Electronic Publication: 2021 Jan 18.
Publication Year :
2021

Abstract

Introduction and Importance: 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.<br />Case Presentation: 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.<br />Clinical Discussion: 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.<br />Conclusion: 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.<br /> (Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Details

Language :
English
ISSN :
2210-2612
Volume :
79
Database :
MEDLINE
Journal :
International journal of surgery case reports
Publication Type :
Report
Accession number :
33508612
Full Text :
https://doi.org/10.1016/j.ijscr.2021.01.059