Extensive Subcutaneous Emphysema after Laparoscopic Cholecystectomy, Two Cases Reports

Abstract

Laparoscopic surgery has expanded its horizon tremendously. It has been the preferred approach in many operations. Massive subcutaneous emphysema is a rare unique complication of laparoscopic surgery. Here, we report two cases that developed progressive extensive subcutaneous emphysema after laparoscopic cholecystectomy. On reviewing the literature, we found that the incidence ranges from 0.43% to 2.34%. There are many risk factors that have been implicated for its development including; pneumo-peritoneum of more than 200 minutes, and insufflation of CO2 at pressure more than 15mm Hg, & PETCO2 more than 50 mmHg. Clinically, subcutaneous emphysema produces an unusual crackling sensation on palpation and graded into four grades according to the severity. The patients should be monitored closely for any cardio-respiratory changes and positive pressure ventilation should be continued until normocarbia is established and signs of respiratory distress & upper airway obstruction are absent. Although conservative supportive measures and close follow up are the only needed strategy in most of cases, however surgical drainage may be beneficial in some case. This achieved either incisions (infraclavicular or submandibular) or tube drainage through different techniques.