Massive subcutaneous emphysema after laparoscopic cholecystectomy: risk factors and treatment

Abstract

Introduction: Laparoscopic surgery, including cholecystectomy, has led to complications such as subcutaneous emphysema (SE) caused by pneumoperitoneum.

Objetive: To describe the conservative clinical management and analyze risk factors such as prolonged surgical time and low Body Mass Index (BMI) associated with a case of massive SE after laparoscopic cholecystectomy.

Material and Method: Descriptive analysis of clinical, imaging, and surgical variables.

Results: A 26-year-old wom-an, BMI 19.1 kg/m2, with cholelithiasis undergoing laparoscopic cholecystectomy, pneumoperitoneum 15 mmHg and surgical time 150 minutes. She experienced mild postoperative abdominal pain. Com-puted tomography (CT) of the abdomen and pelvis revealed extensive subcutaneous and intermuscular emphysema, which progressed favorably and resolved spontaneously.

Discussion: Pneumoperitoneum can cause ES, by causing pressure on surrounding tissues, with carbon dioxide (CO2) penetrating the tissues through the tear in the peritoneum by the entry of the trocars during laparoscopy.

Conclusion: Massive subcutaneous emphysema is a possible complication, especially with prolonged surgical times and in patients with a low BMI. While alarming, its radiological diagnosis should not dictate aggressive interventions if the patient remains hemodynamically and respiratory stable; conservative management is safe and effective.