Journal of Postgraduate Medicine
 Open access journal indexed with Index Medicus & ISI's SCI  
Users online: 5568  
Home | Subscribe | Feedback | Login 
About Latest Articles Back-Issues Article Submission Resources Sections Etcetera Contact
 
  NAVIGATE Here 
  Search
 
 :: Next article
 :: Previous article 
 :: Table of Contents
  
 RESOURCE Links
 ::  Similar in PUBMED
 ::  Search Pubmed for
 ::  Search in Google Scholar for
 ::Related articles
 ::  Article in PDF (10 KB)
 ::  Citation Manager
 ::  Access Statistics
 ::  Reader Comments
 ::  Email Alert *
 ::  Add to My List *
* Registration required (free) 


  IN THIS Article
 ::  Abstract
 ::  Introduction
 ::  Case report
 ::  Discussion
 ::  References

 Article Access Statistics
    Viewed8565    
    Printed192    
    Emailed4    
    PDF Downloaded137    
    Comments [Add]    
    Cited by others 11    

Recommend this journal


   
CASE REPORT
Year : 1990  |  Volume : 36  |  Issue : 1  |  Page : 31-2

Pneumoperitoneum and pneumomediastinum: unusual complications of laparoscopy.


Dept. of Radiology, K.E.M. Hospital, Parel, Bombay, Maharashtra.

Correspondence Address:
Dept. of Radiology, K.E.M. Hospital, Parel, Bombay, Maharashtra.


  ::  Abstract

Pneumoretroperitoneum and pneumomediastinum are rare complications of laparoscopy. We report one such case. The mechanism of development of these complications is explained. No specific treatment needs to be instituted in most of these patients.

How to cite this article:
Shah P, Ramakantan R. Pneumoperitoneum and pneumomediastinum: unusual complications of laparoscopy. J Postgrad Med 1990;36:31


How to cite this URL:
Shah P, Ramakantan R. Pneumoperitoneum and pneumomediastinum: unusual complications of laparoscopy. J Postgrad Med [serial online] 1990 [cited 2020 Apr 10];36:31. Available from: http://www.jpgmonline.com/text.asp?1990/36/1/31/866




  ::   Introduction Top

We present a case of pneumoretroperitoneum and pneumomediastinum following diagnostic laparoscopy. Though well known, this complication is rare. The mechanism of spread of pneumoperitoneum to the retro-peritoneum and mediastinum is not entirely clear.

  ::   Case report Top

A 25-year-old female was subjected to standard laparoscopy for investigation of primary infertility. Two litres of room air was used to induce pneumoperitoneum. The procedure was uneventful. Six hours following the procedure, the patient complained of retrosternal discomfort and hence chest radiography was obtained. A pneumomediastinum was detected on this radiograph. (See [Figure - 1]) An upright film of the abdomen was also done (See [Figure - 2]) to assess a possible pneumoretroperitoneum. The patient was treated symptomatically and was symptom-free at the end of 24 hours.

  ::   Discussion Top

Complications of air insufflation as a part of laparoscopy include subcutaneous emphysema, omental emphysema, pneumoretroperitoneum and pneumomediastinum[4]. In a series of 4048 laparoscopies, pneumomediastinum occurred on one occasion at a complication rate of 0.02%[2]. Neither pheumoretroperitoneum nor pneumomediastinum have any clinical consequence in most of the patients. However, large amount of mediastinal air can produce symptoms due to obstruction of venous return to the heart. Mediastinal emphysema can also result into pneumothorax[3].
The peritoneal cavity is a closed space with no constant communication with the mediastinum or the retroperitoneum. On the other hand, the retroperitoneum and the mediastinum communicate with each other through the oesophageal and aortic hiatus[6].
It is easy to explain the development of pneumoperitoneum following pneumoretroperitoneum[1]. As more and more air accumulates within the potential cavity of the retroperitoneum, the intraperitoneal pressure increases leading to perforation of a weak portion of the mesentery or the parietal peritoneum[1].
On the other hand, it is difficult to explain the development of pneumoretroperitoneum as a consequence of pneumo-peritoneum. It has been postulated that this occurs because of congenital or acquired peritoneal defect[6]. In patients undergoing laparoscopy, it is much more likely that pneumoretroperitoneum results because of faulty technique[5]. This happens when the needle is introduced too far deep into the abdominal cavity and air gets injected into the retroperitoneum. As explained before, this air then finds its way through the oesophageal and aortic hiatus into the mediastinum (See [Figure - 3] and [Figure - 4]).
It should be understood that pneumo-mediastinum as a consequence of pneumoperitoneum can occur independent of the development of pneumoretro-peritoneum; however, the mechanism for this is not clear[6].

  ::   References Top

1. Calenoff L, Poticha SM. Combined occurrence of retropneumoperitoneum and pneurnoperitoneum. Amer J Roentgenol 1973; 117:366-372.  Back to cited text no. 1    
2.Khandwala SD. In: 'Practical laparoscopy', 1st edition, Mumbai: Bhalani Publishing House; 1984, pp 107.  Back to cited text no. 2    
3.Kleinman PK, Brill PW, Whalen JP. Anterior pathway for transdiaphragmatlic extension of pneumomediastinum. Amer J Roentgenol 1978; 131:271-275.  Back to cited text no. 3    
4.Saleh JW. In: "Laparoscopy". Philadelphia: WB Saunders Co.; 1988, pp 255.  Back to cited text no. 4    
5.Saleh JW. In, "Laparoscopy", Philadelphia: WB Saunders Co.; 1988, pp 257.  Back to cited text no. 5    
6.Towbin MN. Mediastinal emphysema occurring with therapeutic pneumoperitoneum: report of ten cases. Ann Int Med 1951; 35:555-592.   Back to cited text no. 6    

Top
Print this article  Email this article
Previous article Next article
Online since 12th February '04
2004 - Journal of Postgraduate Medicine
Official Publication of the Staff Society of the Seth GS Medical College and KEM Hospital, Mumbai, India
Published by Wolters Kluwer - Medknow