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Pulmonary edema after laparoscopic hepatectomy in a patient with B udd– C hiari syndrome‐associated hepatocellular carcinoma
Author(s) -
Hanaoka Marie,
Hara Yoshiaki,
Fujiogi Michimasa,
Fujisawa Nobutaka,
Kawakami Masayo,
Shioiri Sadaaki,
Tanaka Michio,
Yasuno Masamichi
Publication year - 2015
Publication title -
asian journal of endoscopic surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.372
H-Index - 18
eISSN - 1758-5910
pISSN - 1758-5902
DOI - 10.1111/ases.12152
Subject(s) - medicine , hepatocellular carcinoma , hepatectomy , surgery , edema , resection
An 84‐year‐old man diagnosed with B udd– C hiari syndrome ( BCS ) developed a 20‐mm hepatocellular carcinoma. We performed laparoscopic hepatectomy without complications, but the patient's percutaneous oxygen saturation gradually worsened and pulmonary edema was detected 50 minutes after extubation. He was subsequently re‐intubated and received diuretic therapy. He was discharged on postoperative day 32. Patients with severe BCS have been reported to have an expanded plasma volume. In addition, pneumoperitoneum during laparoscopic surgery has been reported to decrease the venous flow in the portal vein and/or renal vein, the collateral pathways in BCS . The cause of pulmonary edema in the present case may have involved increased venous return following decompression of pneumoperitoneum pressure under the state of an expanded plasma volume. This case suggests that clinicians should pay special attention to achieving volume control in patients with BCS , particularly during laparoscopic surgery and minimizing the duration of pneumoperitoneum.