Unbounded Medicine

A previously healthy 63 years old male underwent laparoscopic Nissen fundoplication. Pneumoperitonium was induced with CO2 at a pressure of 13 mmHg. 30 minutes later, he developed hypercarbia (44mmHg) and subcutaneous emphysema without hemodynamic instability, desaturation or fever. Other causes of hypercarbia was ruled out. The procedure was uneventful and completed successfully. Pneumoperitoneum was released. During surgery the patient underwent hyperventilation and the hypercarbia resolved.

Note the color of the skin and the emphysema

Note the color of the skin and the emphysema

Note the changes in the color of the skin

Images courtesy of Mariana Herrera Guerrero, M.D.

More of Subcutaneous emphysema here.