Pneumothorax during laparoscopic plication of diaphragmatic eventration: A case report

Diaphragmatic eventration is the abnormal elevation of the hemidiaphragm or part of it caused due to the lack of muscle or nerve function with normal anatomical attachments. Pneumothorax is a common occurrence during thoracoscopic approaches of diaphragmatic plication but a very rare complication in laparoscopic approaches.A 56-year-old male presented with complaints of pain in the left upper abdomen, bloating, and difficulty in breathing. He was diagnosed with idiopathic diaphragmatic eventration and was taken up for laparoscopic plication under American society of anaesthesiologists – physical status 1. Intra-op, he developed sudden onset increase in peak pressures with poor tidal volumes and desaturation. Examination revealed reduced breath sounds and movement of left side of chest, possibly a left sided pneumothorax. The placement of a left-sided intercostal chest drain led to improvements in ventilatory parameters.The patient was successfully extubated following the completion of surgery.: Pneumothorax is an established complication of laparoscopic surgery, with a reported incidence of 0.01%-0.4%. But early detection and diagnosis of a pneumothorax intraoperatively is difficult and often missed because of controlled ventilation and pneumoperitoneum. A high index of suspicion should be maintained for early diagnosis and management of such conditions.Intraoperative tension pneumothorax and its progression can have devastating consequences. A high index of suspicion, prompt recognition of the condition despite many factors that may mask the condition and prompt remediation leads to an effective management of such cases.