16 April 2024 : Case report
[In Press] Life-Threatening Tracheal Diverticulum Rupture Following Laparoscopic Cholecystectomy: A Rare Case Report
Unusual clinical course, Diagnostic / therapeutic accidents, Management of emergency care, Clinical situation which can not be reproduced for ethical reasons
Gundega Ose12ACEF, Irina Evansa23ABCD, Nikita Ivanovs3AB, Natalija Zlobina3AB, Indulis Vanags24ACDDOI: 10.12659/AJCR.943639
Am J Case Rep In Press; DOI: 10.12659/AJCR.943639
Available online: 2024-04-16, In Press, Corrected Proof
Publication in the "In-Press" formula aims at speeding up the public availability of the pending manuscript while waiting for the final publication. The assigned DOI number is active and citable. The availability of the article in the Medline, PubMed and PMC databases as well as Web of Science will be obtained after the final publication according to the journal schedule
Abstract
BACKGROUND
We present an exceptional case of asystole and tracheal diverticulum rupture as a result of cardiopulmonary resuscitation (CPR) immediately following laparoscopic cholecystectomy performed at Riga 1st Hospital. Tracheal rupture after tracheal intubation is a severe but very rare complication that can be fatal. We present an incidental finding of the tracheal diverticulum and its rupture during CPR.
CASE REPORT
A 71-year-old woman (American Society of Anesthesiologists class II, body mass index 28.58) underwent a planned laparoscopic cholecystectomy. Preoperative chest X-ray showed no abnormalities. Endotracheal intubation was performed, with the first attempt with a 7-mm inner diameter cuffed endotracheal tube without an introducer. Five minutes after rapid desufflation of the pneumoperitoneum, severe bradycardia and hypotension occurred, followed by asystole. CPR was performed for a total of 2 min, until spontaneous circulation returned. Twenty hours after surgery, subcutaneous emphysema appeared on the chest. Computed tomography scan of the chest revealed subcutaneous neck emphysema, bilateral pneumothorax, extensive pneumomediastinitis, and a pocket-like, air-filled tissue defect measuring 10×32 mm in the distal third of the trachea, with suspected rupture. Two hours after the diagnosis was established, the emergent surgery was performed. The patient was completely recovered after 15 days.
CONCLUSIONS
Our case illustrates that tracheal diverticula is sometimes diagnosed by accident and too late, which then can lead to life-threatening situations. Tracheal rupture can be made not only by mechanical piercing by an endotracheal tube but also during interventions, such as CPR. Rapid desufflation of the pneumoperitoneum can lead to asystole, induced by the Bezold-Jarisch reflex.
Keywords: Anesthesia, Endotracheal; Cardiopulmonary Resuscitation; Cholecystectomy, Laparoscopic; Death, Sudden, Cardiac; Rupture, Spontaneous
In Press
02 Apr 2024 : Case report
Langerhans Cell Histiocytosis in Sphenoid Sinus: Uncommon Bone InvolvementAm J Case Rep In Press; DOI: 10.12659/AJCR.942681
03 Apr 2024 : Case report
A Rare Case of Congenital Nephrogenic Diabetes Insipidus Associated with Aquaporin 2 Gene Mutation and Subs...Am J Case Rep In Press; DOI: 10.12659/AJCR.943597
03 Apr 2024 : Case report
Epigastric Pain and Dysphagia in a 36-Year-Old Man Due to Primary Esophageal Small Cell CarcinomaAm J Case Rep In Press; DOI: 10.12659/AJCR.943392
04 Apr 2024 : Case report
Duodenal Soft Tissue Sarcoma with GLI1 Gene Rearrangement: A Case Report and Literature ReviewAm J Case Rep In Press; DOI: 10.12659/AJCR.943271
Most Viewed Current Articles
07 Mar 2024 : Case report
Neurocysticercosis Presenting as Migraine in the United StatesDOI :10.12659/AJCR.943133
Am J Case Rep 2024; 25:e943133
10 Jan 2022 : Case report
A Report on the First 7 Sequential Patients Treated Within the C-Reactive Protein Apheresis in COVID (CACOV...DOI :10.12659/AJCR.935263
Am J Case Rep 2022; 23:e935263
19 Jul 2022 : Case report
Atlantoaxial Subluxation Secondary to SARS-CoV-2 Infection: A Rare Orthopedic Complication from COVID-19DOI :10.12659/AJCR.936128
Am J Case Rep 2022; 23:e936128
23 Feb 2022 : Case report
Penile Necrosis Associated with Local Intravenous Injection of CocaineDOI :10.12659/AJCR.935250
Am J Case Rep 2022; 23:e935250