Post-laparotomy Hypoxia: A Case Series

Abstract

Postoperative hypoxia is a challenge for surgeons. With the advent of better anesthesia and minimal access surgical techniques, the incidence of postoperative hypoxia in elective cases has decreased. However, the incidence in life-saving emergency procedures still poses a possible threat, and cases seem under-reported. We report a series of five cases of postoperative hypoxia after laparotomy. These cases comprise mesenteric laceration, proximal jejunal perforation, perforated duodenal ulcer, abdominal tuberculosis, and fall from height. Despite different etiologies, they landed up with the complication of postoperative hypoxia, which was attributable to the type of procedure they underwent and not the indication of the procedure itself. Thus, they form an interesting collection of post-laparotomy hypoxia cases. We present them with a compilation of probable causes of postoperative hypoxia in such cases. Postoperative hypoxia presents a diagnostic challenge and requires timely suspicion, prompt intervention to eliminate the cause, and good postoperative care. The major causes include incomplete lung re-expansion, pain-induced restriction in chest-wall/diaphragm mobility, prolonged surgery, a complication of pre-existing lung disease, residual effects of some drugs, and iatrogenic causes. We, therefore, recommend the use of postoperative oxygen support and diligent monitoring of vitals in all cases of laparotomy, allowing prompt and timely patient management. Future studies are warranted to explore the prevalence and possible causes of post-laparotomy hypoxia.

Keywords: abdominal surgery; explorative laparotomy; post operative hypoxia; post-laparatomy hypoxia; postoperative care; postoperative hypoxia.

Figure 1. CXR of Case 1 showing right upper lobe consolidation (black arrow)

CXR: chest x-ray

Figure 2. Radiological images of Case 2. (A) CXR showing right lung homogenous opacity (black arrow) suggestive of resorption collapse due to mucus plug; (B) CXR after the removal of the mucous plug

CXR: chest x-ray

Figure 3. Radiological images of Case 3. (A) CXR showing complete homogenous opacification of the left lung (black arrow); (B) CXR after four days of treatment showing left lower zone homogenous opacity (black arrow) with left CP angle obliteration, suggestive of left lung basal lobe atelectasis with pleural effusion; (C) CXR after two weeks of recovery

CXR: chest x-ray; CP: costophrenic

Figure 4. Bronchoscopy of Case 3 showing mucus plug

Figure 5. CXR of Case 4 showing bilateral non-homogenous opacities (black arrows)

CXR: chest x-ray

Figure 6. CXR revealed haziness on both sides of the chest suggestive of bilateral lower zone pneumonitis (black arrows)

CXR: chest x-ray

Figure 7. Possible mechanisms for postoperative hypoxia

Figure credit: Authors; conceptualized from findings suggested by previously reported literature [12] Post-op: postoperative; ARDS: acute respiratory distress syndrome; ALI: acute lung injury