Tension p neu mot ho tax d u r i n g I a pa rosco pi c c ho lecystecto my
Sir
We were interested to read the Case Report by Whiston et al. (Br J Surg 1991; 78: 1325) of tension pneumothorax during laparoscopic cholecystectomy. We recently noted a large, right-sided pneumothorax developing at the end of the procedure on a 53-year-old woman. Pneumoperitoneum was achieved using carbon dioxide via a variable flow pressure-controlled insufflator. In recovery the patient's oxygen saturation (measured by continuous transcutaneous oxygen saturation monitoring) had dropped to 48 per cent. Clinical examination revealed a right-sided pneumothorax, confirmed on chest radiography. While preparations were being made to insert a chest drain, the oxygen saturation was noted to improve and a decision of non-intervention was made One hour later, repeat chest radiography showed the pneumothorax to have completely resolved.
Pneumothorax, as a complication of pneumoperitoneum, was first noted in the 1940s, when pneumoperitoneum was used in the treatment of tuberculosis'. Subsequently, there have been many case reports and reviews in the literature of this complication following peritoneosc~py~-~. In 1973 Doctor and Hussain' promoted the use of carbon dioxide as an insufflating agent because ofits high diffusibility.
This carbon dioxide pneumothorax resolved rapidly and suggests that there is a place for conservative management of carbon dioxide pneumothorax.