Bilateral pneumothorax during laparoscopic distal gastrectomy: A case report

A 69-year-old man was scheduled for laparoscopic distal gastrectomy. He had pulmonary emphysema and a smoking history. Ninety eight minutes after the beginning of CO₂ insufflation (10 mmHg), Sp_O2 decreased from 99 to 95%, Et_CO2 increased from 35 to 39 mmHg While I investigated its cause, SP_O2 decreased to 94% (FI_O21.0), Et_CO2 increased to 59 mmHg. Intraoperative chest X-ray showed bilateral pneumothorax without pneumomediastinum and subcutaneous emphysema Discussing with surgeons, we judged that the continuation of the pneumoperitonium was high-risk and performed open distal gastrectomy. Because it was both side pneumothorax and he was complicated with pulmonary emphysema After the end of the surgery, chest X-ray revealed complete resolution of pneumothoraces. The patient was moved to a general ward after tracheal extubation. As a cause of pneumothorax, the carbon dioxide inflow from the diaphragmatic weak part was suspected. Because it is hard to notice a decrease in pulmonary compliance during pressure controlled ventilatioa the appropriate alarm setting of a tidal volume is necessary.