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Tanaka Y, Amano T, Nakata M, Takahashi A, Tsuji S, Murakami T. Cases of pleural effusion possibly due to clinical pleuroperitoneal communication in the perioperative period of emergency gynecologic surgery: Case series and literature review. J Obstet Gynaecol Res 2024; 50:734-739. [PMID: 38196307 DOI: 10.1111/jog.15882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 12/28/2023] [Indexed: 01/11/2024]
Abstract
Pleuroperitoneal communication poses a respiratory failure risk due to pleural fluid accumulation with thoracic migration of ascites. Here, we discuss the following cases: Case 1: A woman was diagnosed with a ruptured ovarian tumor with right pleural fluid and ascites, without respiratory failure. Ovarian cystectomy was performed with inadequate removal of ascites. Postoperatively, respiratory failure occurred, and thoracentesis detected pleural fluid resembling ascites. Case 2: A woman was diagnosed with a ruptured ectopic pregnancy with right pleural fluid and ascites without respiratory failure. A diagnosis of clinical pleuroperitoneal communication was considered based on computed tomography findings. During laparoscopic salpingectomy, high-pressure ventilation was performed to push the pleural fluid back into the abdominal cavity; a negative-pressure drain was inserted, and the ascites was completely removed. Postoperative radiography revealed the absence of pleural fluid. Therefore, a preoperative diagnosis of clinical pleuroperitoneal communication and appropriate intraoperative techniques can prevent postoperative respiratory failure.
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Affiliation(s)
- Yuji Tanaka
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Tsukuru Amano
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Mari Nakata
- Department of Obstetrics and Gynecology, National Hospital Organization Higashi-ohmi General Medical Center, Higashiomi, Shiga, Japan
| | - Akimasa Takahashi
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Shunichiro Tsuji
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Takashi Murakami
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Otsu, Shiga, Japan
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Leal C, Villegas J, Guigón M, Rubio V, Valenzuela A. "Complications of Gynecologic Surgery": ¨CO2 Massive Pneumothorax after a Total Laparoscopic Hysterectomy ¨. J Minim Invasive Gynecol 2021; 29:455-456. [PMID: 34896657 DOI: 10.1016/j.jmig.2021.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/01/2021] [Accepted: 12/03/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Carlos Leal
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Universidad Autónoma de Chihuahua, Hospital Christus Muguerza Del Parque, Chihuahua México.
| | - Jesús Villegas
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Universidad Autónoma de Chihuahua, Hospital Christus Muguerza Del Parque, Chihuahua México
| | - Miguel Guigón
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Universidad Autónoma de Chihuahua, Hospital Christus Muguerza Del Parque, Chihuahua México
| | - Víctor Rubio
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Universidad Autónoma de Chihuahua, Hospital Christus Muguerza Del Parque, Chihuahua México
| | - Alejandra Valenzuela
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Universidad Autónoma de Chihuahua, Hospital Christus Muguerza Del Parque, Chihuahua México
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3
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Siddiqui SN, Memon M, Hasan T. Bilateral pleural effusion and pneumomediastinum: rare complication resulting from punctured left subclavian vein following insertion of PICC line for total parenteral nutrition. BMJ Case Rep 2021; 14:14/7/e244093. [PMID: 34330728 PMCID: PMC8327836 DOI: 10.1136/bcr-2021-244093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
This is a rare case of development of bi-lateral chylous pleural effusion (containing parenteral nutrition material) along with pneumomediastinum due to punctured left subclavian vein following insertion of a peripherally inserted central venous catheter (PICC) line. Parenteral nutrition is usually preferred for patients unable to tolerate enteral feeding. Due to hypertonicity of the total parenteral nutrition material, it is usually administered via internal jugular or subclavian vein which have a rapid blood flow; therefore, resulting in adequate mixing. Literature studies are yet to clearly explain the communications between two pleural cavities; therefore, development of bilateral pleural effusions in association with pneumomediastinum makes this case more intriguing. We present the journey of a 43-year-old woman who required insertion of bilateral chest drains, followed by sternotomy and repair of the left subclavian vein after she was found in hypoxic respiratory failure 2 days following insertion of PICC line into her left subclavian vein.
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Affiliation(s)
- Saquib Navid Siddiqui
- Respiratory Medicine & General Internal Medicine, Northumbria Healthcare NHS Foundation Trust, North Shields, Tyne and Wear, UK
| | - Muhammad Memon
- Geriatric Medicine, William Harvey Hospital, Ashford, Kent, UK
| | - Tanveer Hasan
- Geriatric Medicine, William Harvey Hospital, Ashford, Kent, UK
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4
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Chao WT, Jiang LY, Chen GY, Wang PH, Wu HH, Chen YJ. Right postoperative pleural effusion and pulmonary embolism following laparoscopic gynecological surgery: A rare case report and PRISMA-driven systematic review. J Chin Med Assoc 2019; 82:957-961. [PMID: 31135576 DOI: 10.1097/jcma.0000000000000125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The incidence of postlaparoscopic pleural effusion and pulmonary embolism were rare. However, it might be life-threatening. Therefore, confirming the risk factor and management is important. We present a 53-year-old woman with ovarian endometriosis arranged for laparoscopic surgery. However, desaturation was noted on postoperation day 1. Chest radiograph and chest computed tomography showed pleural effusion and pulmonary embolism. Pleural pigtail insertion was performed and anticoagulant medication, albumin, and lasix were given. The patient's recovery was uneventful. Several factors have been advanced to explain including the prolonged duration of the operation. Management options include supplemental oxygen therapy, and pigtail catheter insertion. Mechanical prophylaxis (sequential compression devices and graduated compression stockings) is sufficient for venous thromboembolism prevention.
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Affiliation(s)
- Wei-Ting Chao
- Faculty of Medicine, College of Medicine, Fu-Jen Catholic University, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ling-Yu Jiang
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Guan-Yeu Chen
- Faculty of Medicine, College of Medicine, Fu-Jen Catholic University, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Peng-Hui Wang
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan, ROC
| | - Hua-Hsi Wu
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Yi-Jen Chen
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
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5
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Paul PG, Mathew T, Shintre H, Bulusu S, Paul G, Mannur S. Postoperative Pulmonary Complications Following Laparoscopy. J Minim Invasive Gynecol 2017; 24:1096-1103. [PMID: 28735736 DOI: 10.1016/j.jmig.2017.06.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Revised: 06/15/2017] [Accepted: 06/15/2017] [Indexed: 11/28/2022]
Abstract
Postoperative pulmonary complications (PPCs) unrelated to anesthesia, especially hydropneumothorax, are rare after gynecologic laparoscopy. Hydropneumothorax can cause respiratory failure and be life-threatening, however. Awareness, prompt diagnosis, and timely intervention are crucial for clinical management. We review the literature for PPCs, including pneumothorax, hydrothorax, hydropneumothorax, and pleural effusion following laparoscopy, and also present a recent case of hydropneumothorax seen at our institution.
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Affiliation(s)
- P G Paul
- Paul's Hospital, Centre for Advanced Endoscopy and Infertility, Kochi, Kerala, India.
| | - Thampi Mathew
- Paul's Hospital, Centre for Advanced Endoscopy and Infertility, Kochi, Kerala, India
| | - Hemant Shintre
- Paul's Hospital, Centre for Advanced Endoscopy and Infertility, Kochi, Kerala, India
| | - Saumya Bulusu
- Paul's Hospital, Centre for Advanced Endoscopy and Infertility, Kochi, Kerala, India
| | - George Paul
- Paul's Hospital, Centre for Advanced Endoscopy and Infertility, Kochi, Kerala, India
| | - Sumina Mannur
- Paul's Hospital, Centre for Advanced Endoscopy and Infertility, Kochi, Kerala, India
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Shin YM, An JH, Lee C, Park JY, Ban JS, Lee SG. Increased amount of pleural effusion during head-down tilt position in ovarian cancer patient with ascites −A case report−. Anesth Pain Med (Seoul) 2016. [DOI: 10.17085/apm.2016.11.2.182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Young-min Shin
- Department of Anesthesiology and Pain Medicine, Daegu Fatima Hospital, Daegu, Korea
| | - Ji-hyun An
- Department of Anesthesiology and Pain Medicine, Daegu Fatima Hospital, Daegu, Korea
| | - Chiu Lee
- Department of Anesthesiology and Pain Medicine, Daegu Fatima Hospital, Daegu, Korea
| | - Jun-yi Park
- Department of Anesthesiology and Pain Medicine, Daegu Fatima Hospital, Daegu, Korea
| | - Jong Seouk Ban
- Department of Anesthesiology and Pain Medicine, Daegu Fatima Hospital, Daegu, Korea
| | - Sang Gon Lee
- Department of Anesthesiology and Pain Medicine, Daegu Fatima Hospital, Daegu, Korea
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Sato HR, Muntz HG. Hydrothorax after robotic-assisted surgical staging of endometrial cancer. GYNECOLOGIC ONCOLOGY CASE REPORTS 2012; 3:14-5. [PMID: 24371654 DOI: 10.1016/j.gynor.2012.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Accepted: 10/13/2012] [Indexed: 11/19/2022]
Abstract
► Hydrothorax from a pleuroperitoneal leak is a rare complication of laparoscopy. ► First case report of hydrothorax during robot-assisted laparoscopic surgery. ► Consider hydrothorax if new onset respiratory compromise after laparoscopy.
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Affiliation(s)
- Holly R Sato
- Women's Cancer Care of Seattle, Northwest Hospital & Medical Center, University of Washington Medicine, USA
| | - Howard G Muntz
- Women's Cancer Care of Seattle, Northwest Hospital & Medical Center, University of Washington Medicine, USA
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8
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Hahm TS, Ham JS, Kang JY. Unilateral massive hydrothorax in a gynecologic patient with pseudo-Meigs' syndrome -A case report-. Korean J Anesthesiol 2010; 58:202-6. [PMID: 20498801 PMCID: PMC2872861 DOI: 10.4097/kjae.2010.58.2.202] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2009] [Revised: 09/18/2009] [Accepted: 10/01/2009] [Indexed: 11/28/2022] Open
Abstract
Pseudo-Meigs' syndrome is characterized by the presence of a benign ovarian tumor associated with ascites and a right-sided hydrothorax. The major problem associated with pseudo-Meigs' syndrome is the respiratory distress caused by a giant mass in the peritoneal space, massive ascites and pleural effusion. Even if there are no respiratory problems prior to surgery, potential respiratory dysfunction can occur during the peri-anesthetic period, leading to hypoxia, hypercapnea and respiratory acidosis. We report a case of hypoxia during recovery from anesthesia in a gynecological patient with pseudo-Meigs' syndrome.
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Affiliation(s)
- Tae Soo Hahm
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Ronghe R, Bjornsson S, Hannah P. Pleural effusion following use of saline and fluid anti-adhesion agents at laparoscopic surgery--a case series of three patients. BJOG 2009; 116:1524-6. [PMID: 19538419 DOI: 10.1111/j.1471-0528.2009.02224.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- R Ronghe
- Department of Obstetrics and Gynaecology, Southern General Hospital, Glasgow, UK
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10
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Abstract
Laparoscopy for urological surgery is a relatively recent surgical innovation. Some centres have substantial experience of single operations, but very few have experience with a comprehensive range. Our programme began with nephrectomy and pyeloplasty, and has expanded to provide for a living related kidney donor programme and for other procedures usually conducted open. Recently, it has included prostate and bladder cancer surgery. The learning curve and implications for anaesthesia are described on the basis of the experience of one anaesthetist with 124 patients. Perioperative care issues, in common with other abdominal laparoscopic procedures, relate to operating positions, the consequences of carbon dioxide under pressure in the abdomen and postoperative analgesia. There is only a small requirement for regional anaesthesia supplementation and invasive analgesia. The corporate laparoscopic cholecystectomy experience was used as the foundation for anaesthesia and to delineate specific organ system issues and any interventions. Significant differences were found in the spectrum of the urological patient population and comorbidity, notably renal function or dysfunction, and complications.
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Affiliation(s)
- I D Conacher
- Freeman Hospitals Trust, Newcastle upon Tyne, UK.
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11
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Pendeville P, Boufroukh D, Aunac S, Donnez J, Lengele B. [Peroperative desaturation during gynaecological laparoscopy-hysteroscopy: an unknown aetiology, pleural extravasation]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2003; 22:553-6. [PMID: 12893384 DOI: 10.1016/s0750-7658(03)00139-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
A 41-year-old patient presented several episodes of desaturation during a gynaecological laparoscopy. The major complication of this procedure is the venous air embolism. Several other side-effects have been reported: heart rate disorders, subcutaneous emphysema or pneumothorax. Pleural effusions during gynaecologic laparoscopy are apparently rare and the volume of effusion must be important to induce clinical symptoms. This fact can probably explain the frequent difficulty of diagnosis. The role of the diaphragmatic lymphatic network and other physiologic aspects are discussed in this article.
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Affiliation(s)
- P Pendeville
- Service d'anesthésiologie, cliniques universitaires Saint-Luc, 10, avenue Hippocrate, 1200 Bruxelles, Belgique.
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12
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Paw HGW. Bilateral pleural effusions: unexpected complication after left internal jugular venous catheterization for total parenteral nutrition. Br J Anaesth 2002; 89:647-50. [PMID: 12393371 DOI: 10.1093/bja/aef224] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Bilateral pleural effusions occurred after total parenteral nutrition was administered via a left internal jugular venous line. The most likely explanation for the fluid passage into both pleural cavities was migration of the tip of the catheter from within the vein into the mediastinum. Fluid can pass into both pleural cavities via anatomical communications, yet to be described, which exist between the two pleural cavities.
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Affiliation(s)
- H G W Paw
- Intensive Care Unit, York District Hospital, Wigginton Road, York YO31 8HE, UK
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