Abstract
BackgroundIn patients undergoing abdominal radiotherapy or transurethral surgery, bladder perforations are a possible complication. Likewise, pleural effusions due to a pleuroperitoneal leak caused by either a congenital or acquired diaphragmatic defect can also occur. We report a case in which a saline solution, which migrated into the abdominal cavity from a bladder perforation during transurethral electrocoagulation, further formed bilateral pleural effusions and caused rapid ventilation failure.Case presentationA patient undergoing radiation therapy and hormone therapy for prostate cancer underwent emergency surgery for electrocoagulation due to hematuria and a rapid drop in hemoglobin. The surgery began under general anesthesia, and we first noticed an increase in airway pressure and a decrease in dynamic lung compliance, followed by abdominal distension. Based on readouts from the respiratory mechanics monitor, we suspected lung abnormalities and performed a pulmonary ultrasound, leading to a diagnosis of bilateral pleural effusions, which we then drained.ConclusionsRespiratory mechanics monitoring is simple and can be performed at all times during anesthesia, and when combined with pulmonary ultrasound, diagnoses can be made quickly and prevent deaths.
Highlights
In patients undergoing abdominal radiotherapy or transurethral surgery, bladder perforations are a possible complication
Case presentation A 70-year-old man undergoing radiation therapy and hormone therapy for prostate cancer was admitted to the hospital for macro hematuria and anorexia
The patient had no problems with peak airway pressure of about 22 c mH2O, and the dynamic lung compliance showed about 35 mL/cmH2O until 8 min after the start of surgery. (Fig. 2) Nine minutes after the start of surgery, the peak airway pressure suddenly increased to 31 cmH2O, and dynamic lung compliance decreased to 18 ml/cmH2O. (Fig. 2) Oxygen saturation measured by pulse oximeter (SpO2) fell below 90%, so we decided to use pure oxygen, and changed the airway to a tracheal tube and intubated with a McGrathTMMAC (Covidien Japan, Tokyo) laryngoscope, but lung compliance and oxygenation did not improve
Summary
Respiratory mechanics monitoring is simple and can be performed at all times during anesthesia, and when combined with pulmonary ultrasound, diagnoses can be made quickly and prevent deaths.
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