We successfully treated a 59-year-old male with adenocarcinoma in the right lower lobe who had developed a dead space with prolonged air-leak, which continued for 21 days after lower and middle lobectomy, by creating artificial pneumoperitoneum. He had a history of subtotal gastrectomy due to stomach cancer 5 years ago. Artificial pneumoperitoneum was made after introducing a peritoneal dialysis catheter into the right upper quardrant. The chest tube was removed 14 days after creating pneumoperitoneum.
Adenocarcinoma ; Catheters ; Chest Tubes ; Gastrectomy ; Humans ; Male ; Middle Aged ; Peritoneal Dialysis ; Pneumoperitoneum ; Pneumoperitoneum, Artificial* ; Stomach Neoplasms

Pulmonary resection often leaves a pleural space problem that can cause prolonged air leaks. We describe a patient with lung cancer undergoing a right middle and lower lobectomy complicated by prolonged air leaks. He had a history of pulmonary tuberculosis and COPD. Artificial pneumoperitoneum was made by instillation of air via a small central vein catheter into the left lower quadrant on postoperative day(POD) 21. The air leak ceased on POD 23 and the chest tube was removed on POD 25.
Catheters ; Chest Tubes ; Humans ; Lung Neoplasms ; Pneumoperitoneum ; Pneumoperitoneum, Artificial* ; Pulmonary Disease, Chronic Obstructive ; Tuberculosis, Pulmonary ; Veins

BACKGROUND: Laparoscopic surgery is replacing conventional surgical techniques due to its many advantages. However the possibility of respiratory complications during CO2-induced pneumoperitoneum remain. Tracheal gas insufflation (TGI) has been shown to be a useful adjunct to mechanical ventilation in hypercapneic patients. This study investigated the effectiveness of TGI in reducing the PaCO2 level in hypercapneic patients during laparoscopic surgery without increasing the peak inspiratory pressure (PIP) and usefulness of a Univent tube(R) as a device for TGI. METHODS:Twenty-four patients who were scheduled to undergo gynecological laparoscopic surgery, were enrolled in this study. Anesthesia was induced and maintained with propofol, rocuronium and N2O-O2-sevoflurane. The suction port of the endobronchial blocker of the Univent tube(R) was used for the path of TGI. Data including the ABGA and respiratory parameters were measured three times, the pre-CO2 peritoneum (pre-CO2 pneumoperitoneum point, PCP), 15 min after CO2 peritoneum (after-CO2 pneumoperitoneum point, ACP) and after 15 min TGI (TGI point, TGIP). RESULTS: At ACP, the PaCO2 and PIP had increased more significantly than PCP. After TGI, the PaCO2 was decreased more significantly than ACP, but the PIP did not increased. CONCLUSIONS: TGI is a useful adjunct to mechanical ventilation in hypercapneic patients during laparoscopic surgery, and a univent tube(R) is an economic and convenient device for TGI.
Anesthesia ; Humans ; Insufflation* ; Laparoscopy* ; Peritoneum ; Pneumoperitoneum ; Propofol ; Respiration, Artificial ; Suction

Spontaneous gastric perforation of the newborn is a rare, serious and life-threatening problem. This is surgical emergency because of high mortality. Most historical reports have described gastric perforation in the neonate as spontaneous cause. But, recent reviews report the contributing factor including prematurity and mechanical ventilation. Usually clinician identifies the pneumoperitoneum in simple abdomen X-ray. The final diagnostic method is surgical finding and the treatment of gastric perforation is immediate surgical correction. Early diagnosis, hemodynamic monitoring and fluid therapy for hypovolemia improve outcome. Pseudocyst formation after gastric perforation is very rare in newborn. We report a rare case of pseudocyst formation after spontaneous gastric perforation in full term newborn.
Abdomen ; Early Diagnosis ; Emergencies ; Fluid Therapy ; Hemodynamics ; Humans ; Hypovolemia ; Infant, Newborn ; Mortality ; Pneumoperitoneum ; Respiration, Artificial

Colectomy ; Embolism, Air ; etiology ; Humans ; Laparoscopy ; Male ; Middle Aged ; Pneumoperitoneum, Artificial ; adverse effects

Massive pneumopritoneum developing immediately following initiation of artificial ventilation is an unusual sign of lung barotrauma and must be distinguished from pneumoperitoneum following rupture of a hollow abdominal viscus. Besides, pneumoperitoneum occurring in a mechanically ventilated asthmatic patient can present a diagnostic dilemma as the usual signs of an intestinal perforation may be masked by steroid therapy, sedation or paralysis, or combination of all three. We report a case of massive pneumoperitoneum after initiation of mechanical ventilation in a child with severe asthmatic attack.
Asthma* ; Barotrauma ; Child* ; Humans ; Intestinal Perforation ; Lung ; Masks ; Paralysis ; Pneumoperitoneum* ; Respiration, Artificial* ; Rupture ; Ventilation

Despite numerous benefits of laparoscopic procedures, during carbon dioxide-induced pneumoperitoneum, the serious hypercapnia and respiratory acidosis in hypercapnic patients with decreased pulmonary compliance may be developed. Tracheal gas insufflation (TGI) has been shown to be a useful adjunct to controlled mechanical hypoventilation. However, the utility of TGI in hypercapnic management during laparoscopic surgery was not reported yet. We report a case that TGI superimposed on controlled mechanical ventilation corrected hypercapnia induced by carbon dioxide-induced pneumoperitoneum during laparoscopic salphingo-oophorectomy. There was no specific anesthetic problem during operation, patients was discharged uneventfully.
Acidosis, Respiratory ; Carbon ; Carbon Dioxide ; Compliance ; Humans ; Hypercapnia* ; Hypoventilation ; Insufflation* ; Laparoscopy* ; Pneumoperitoneum ; Respiration, Artificial

Hernia, Inguinal ; surgery ; Humans ; Male ; Middle Aged ; Pneumoperitoneum, Artificial ; Scrotum ; surgery

In this study, we investigated the effect of different values of intra-abdominal pressure on bacterial translocation. Twenty-four Wistar-Albino rats were divided into four groups. The animals belonging to the Control group were not subjected to any increased intra-abdominal pressure. In groups I, II and III, an intra-abdominal pressure of 14, 20, and 25 mmHg, respectively, was established by carbon dioxide pneumoperitoneum for a period of 60 minutes. Four hours after the pneumoperitoneum, all animals were sacrificed to evaluate the degree of bacterial translocation at this time. Liver, spleen and mesenteric lymph nodes were excised under sterile conditions. Bacterial growth was assessed using standard bacteriological techniques and compared statistically. The Kruskal-Wallis and Mann-Whitney U tests were used for the statistical analysis. Different amounts of bacterial growth were found in all of the animals subjected to increased intra-abdominal pressure, except for the controls. Bacterial translocation was detected at an intra-abdominal pressure of 14 mmHg but this finding was not statistically significant (p > 0.05). There was a significant increase in bacterial growth in animals subjected to an intra- abdominal pressure of 20 mmHg or above (p < 0.001). As a result, we found that bacterial translocation started when the intra-abdominal pressure reached a level of 14 mmHg. Patients should be closely monitored for septic complication risks following laparoscopic procedures in which the intra-abdominal pressure exceeds 20 mmHg.
Abdomen ; Animals ; *Bacterial Translocation ; Carbon Dioxide ; Laparoscopy/*adverse effects ; Pneumoperitoneum, Artificial/adverse effects ; Pressure ; Rats ; Rats, Wistar ; Splanchnic Circulation

OBJECTIVETo investigate the influence of CO(2) and He insufflation administered at different pressures on the migration and cytoskeleton of cultured human gastric cancer cells.

METHODSThe cultured gastric cancer cells MKN-45 were exposed to a CO(2) or He environment maintained at different pressures (12, 15 mm Hg). After 0, 2, 4, 6, 8 hours exposure to CO(2) or He environment, pH of the MKN-45 cells culture media was measured with blood gas analysis. The cell migration was detected with Transwell technology. The cell cytoskeleton was observed with laser confocal microscope.

RESULTSThe media pH was acid after exposure to CO(2) environment, while it was basic in the He group. The number of cells passing millipore in 12 mm Hg CO(2) or He insufflation pressure were not significantly different with control group (P>0.05), however in 15 mm Hg pressure CO(2) group, it was significantly decreased as compared to control group (P<0.01). The microfilament and microtubule in gastric cancer cell were ambiguous in 15 mm Hg pressure CO(2) group.

CONCLUSIONSThere are no obvious effects on the migration and cytoskeleton of MKN-45 cells under 12 mm Hg CO(2) insufflation pressure. The migration and cytoskeleton of MKN-45 cells can be inhibited in 15 mm Hg CO(2) pneumoperitoneum environment.

Carbon Dioxide ; administration & dosage ; Cell Line, Tumor ; Cell Movement ; Cell Survival ; Cytoskeleton ; Humans ; Pneumoperitoneum, Artificial ; Pressure ; Stomach Neoplasms ; ultrastructure