171/401. Laparoscopic cholecystectomy: anesthesia-related complications and guidelines. Although laparoscopic cholecystectomy is gaining worldwide acceptance, it is associated with some nonsurgical complications. We report the occurrence of massive subcutaneous emphysema, bradycardia, malfunctioning oximeters, pulmonary edema, endobronchial intubation, and the patient falling from the table with change in position during this surgical procedure. Choice of anesthetics, commonly occurring anesthetic complications, and management of these problems during laparoscopic surgery are discussed. ( info) |
172/401. Surgical emphysema following a restorative procedure: A case report. Surgical emphysema is a rare complication following a restorative procedure, despite the use of air-driven handpieces. Although most cases resolve spontaneously, it should be correctly managed to avoid potentially life-threatening situations, such as pneumomediastinum and pneumothorax. CLINICAL RELEVANCE: Surgical emphysema, although rare, can occur following certain dental procedures. It should be avoidable but, when it occurs, appropriate management is essential. ( info) |
173/401. "Punk" rock can be bad for you: a case of surgical emphysema from a "punk" rocker's leather jacket. Stab wounds to the thorax are seen in the emergency department (ED) and can be caused by a variety of mechanisms. This case highlights an unusual cause of injury: a leather jacket with spikes on the back of it. This type of jacket is often worn by "punks" as a fashion statement. We report that falling onto such a jacket may result in accidental thoracic injury leading to subcutaneous emphysema. A thorough clinical assessment is mandatory to exclude underlying lung injury or pneumothorax. In patients with subcutaneous emphysema and an otherwise normal chest radiograph, an in hospital observation period of 24 hours to check for any delayed complications is adequate if the patient remains clinically stable. ( info) |
174/401. Spontaneous pneumopericardium, pneumomediastinum and subcutaneous emphysema: unusual complications of asthma in a 2-year-old boy. A 2-year-old boy presented to the emergency department with a history of sudden onset of cough, dyspnoea and a slight expiratory wheeze on the right lung base. He also had subcutaneous emphysema on the left side of the chest anteriorly. Chest x ray confirmed subcutaneous emphysema and also revealed pneumomediastinum and pneumopericardium. He had had no previous episode and was not known to have asthma. He was apyrexial but had a raised white cell count. The eosinophil count was within normal limits. He was successfully treated with nebulised salbutamol, steroids, antibiotics and high flow oxygen. He made a good recovery and was discharged after 7 days. This case highlights the need for a high index of suspicion of asthma in very young children presenting for the first time with such complications. ( info) |
175/401. subcutaneous emphysema along cutaneous striae after laparoscopic surgery: a unique complication. A case of postlaparoscopic subcutaneous emphysema developed along cutaneous striae was reported. A 35-year-old male patient with marked cutaneous striae underwent hand-assisted laparoscopic proctocolectomy for steroid-dependent ulcerative colitis. After an uneventful surgery, he developed subcutaneous emphysema, which was noted along the cutaneous striae in the bilateral thigh. The localization of emphysema suggested that Pfannensteil mini-laparotomy for hand access was most responsible for the development of subcutaneous emphysema. ( info) |
176/401. Spontaneous tracheal rupture after severe coughing in a 7-year-old boy. Tracheal lacerations are rare but potentially life-threatening. They are recognized sequelae of cervical or thoracic injuries or complications of endotracheal intubation. Spontaneous tracheal rupture is extremely uncommon and has not been reported in a pediatric patient. This report is the first pediatric case of a spontaneous longitudinal laceration of the posterior membranous cervical trachea, which occurred after violent coughing in a 7-year-old boy with acute tracheobronchitis. The tracheal rupture was detected early with an endoscopic examination and computed tomography. The rupture and emphysema were small, with no major complications, and disappeared with conservative management. This rare case is presented with a review of the possible mechanism, diagnosis, and treatment. ( info) |
177/401. Cervicofacial and mediastinal emphysema complicating a dental procedure. Cervicofacial subcutaneous emphysema is an infrequently reported sequela of dental surgery. It may be caused by the inadvertent introduction of air into the soft tissues during procedures using high-speed, air-driven handpieces or air-water syringes. In this paper, we present a case in which subcutaneous emphysema developed in a middle-aged woman following routine restorative treatment. We review the features of the condition and its treatment and discuss means of prevention. ( info) |
| We report on an 18-year-old male with bronchial asthma who presented with swelling over the neck and upper chest after a mild episode of bronchospasm. physical examination was suggestive of subcutaneous emphysema, which was subsequently confirmed on a radiograph. Computed tomography in addition revealed pneumomediastinum and air within the epidural space of the spinal canal. Although spontaneous pneumomediastinum and subcutaneous emphysema have been described in a variety of situations, including patients with asthma, spontaneous pneumorrhachis in asthmatics is a very rare entity. ( info) |
179/401. Boerhaave's syndrome in children: a case report and review of the literature. Boerhaave's syndrome or spontaneous rupture of the esophagus is a rupture of the esophagus after vomiting. It is rare in children, and to date, 26 children have been reported. We present the case of a 5-year-old boy who presented with dyspnea after vomiting and subcutaneous emphysema. The diagnosis was confirmed with esophagoscopy. The patient was successfully treated with a repair of the rupture and a fundoplication. We review the literature on Boerhaave's syndrome in children. ( info) |
180/401. Management of near fatal blunt laryngeal trauma. Blunt laryngeal trauma is uncommon, difficult to diagnose and recommended assessment and management guidelines differ. mortality can be as high as 40%. Initial symptoms might mask the seriousness of the injury and a history of trauma is important. This report describes a case which illustrates many of the difficulties encountered. A high index of suspicion is needed, and all patients with a suspected blunt laryngeal injury, even with minor symptoms, should be taken seriously and considered for early precautionary airway intervention. ( info) |