Laparoscopic surgery-associated massive subcutaneous emphysema requiring mechanical ventilation in a patient with endometriosis: a case report

Abstract

Although subcutaneous emphysema is a common benign complication of laparoscopic surgery, airway obstruction can occur due to pharyngeal emphysema when it extends to the neck. Here, we report a case of subcutaneous emphysema extending to the neck that required mechanical ventilation in a 51-year-old patient with endometriosis and severe adhesions during total laparoscopic hysterectomy and bilateral salpingo-oophorectomy. Although surgical or disease-specific risk stratification has not yet been established, the severe adhesions due to endometriosis and massive peritoneal defect due to the procedure might lead to the fragility of the subcutaneous tissue, resulting in a massive subcutaneous emphysema. This study highlights the importance of preoperative risk assessment in addition to intraoperative and postoperative monitoring for ventilation disorders and subcutaneous emphysema.

Figure 1

A large right ovarian cyst adherent to the uterus and retroperitoneum was identified within the Douglas cavity.

Figure 2

The peritoneum was massively disrupted such that the upper and lower peritoneum could not be sutured.

Figure 3

Chest radiography demonstrating the progression of the subcutaneous emphysema to the mandible (arrows).