Abstract
Herein, we present and review a case of hypercarbia associated with ventilation difficulty and severe subcutaneous emphysema during laparoscopic low anterior resection to treat rectal cancer. An octogenarian with a diagnosis of advanced rectal cancer had been scheduled for laparoscopic low anterior resection. Hypercarbia was noticed 3h after the start of the operation and was associated with ventilation difficulty and subcutaneous emphysema from the anterior chest wall. A chest radiography showed no pneumothorax. However, massive subcutaneous emphysema was detected from the bilateral axilla to the neck. We stopped the laparoscopic procedure and reduced insufflation pressure from 10 mmHg to 8 mmHg. Thereafter, the ventilation disorder was improved, and we were able to continue the laparoscopic procedure without hypercarbia. The postoperative course was good, without further hypercarbia. Although subcutaneous emphysema is a common complication of laparoscopic surgery, ventilation difficulty combined with severe subcutaneous emphysema is rare. In this case, we believe that the reason for such a rare occurrence was that the patient presented with several risk factors for subcutaneous emphysema, such as age, and weakness in the subcutaneous tissue. Therefore, in such high-risk cases, it is important to cooperate with the anesthetist to ensure early detection and prevention of a fatal event.
