Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 16, 2022; 10(5): 1684-1688
Published online Feb 16, 2022. doi: 10.12998/wjcc.v10.i5.1684
Pneumothorax during retroperitoneal laparoscopic partial nephrectomy in a lupus nephritis patient: A case report
Yi Zhao, Xiao-Qiang Xue, Di Xia, Wei-Feng Xu, Guang-Hua Liu, Yi Xie, Zhi-Gang Ji
Yi Zhao, Xiao-Qiang Xue, Wei-Feng Xu, Guang-Hua Liu, Yi Xie, Zhi-Gang Ji, Department of Urology, Peking Union Medical College Hospital, Beijing 100730, China
Di Xia, Department of Anesthesiology, Peking Union Medical College Hospital, Beijing 100730, China
Author contributions: Zhao Y and Xue XQ are co-first authors who contributed equally to this work; Zhao Y and Xue XQ reviewed the literature, acquired the data, and contributed to manuscript drafting; Xu WF, Liu GH, Xia D, and Xie Y contributed to manuscript revision; Xia D provided further interpretation of the figures and data; Ji ZG managed the patient, performed the operation, and was responsible for the revision of the manuscript for important intellectual content. All authors issued final approval for the version to be submitted.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zhi-Gang Ji, MD, Chief Doctor, Professor, Department of Urology, Peking Union Medical College Hospital, No. 1 Shuaifuyuan Road, Dongcheng District, Beijing 100730, China. jizhiganguro@126.com
Received: August 26, 2021
Peer-review started: August 26, 2021
First decision: October 22, 2021
Revised: October 24, 2021
Accepted: January 5, 2022
Article in press: January 5, 2022
Published online: February 16, 2022
Processing time: 168 Days and 17.4 Hours
Abstract
BACKGROUND

Downgrading target treatment and laparoscopic partial nephrectomy have become increasingly popular in patients with renal cell carcinomas. Rare as it is, pneumothorax is one of the most severe intraoperative complications which needs immediate recognition. On the other hand, as a rheumatological disease, lupus nephritis requires a long period of hormone therapy. Cases of pneumothorax in hormone-consuming renal cancer patients are even fewer.

CASE SUMMARY

A 39-year-old woman was admitted to our department to take a laparoscopic partial nephrectomy. The patient had a medical history of lupus nephritis and renal clear cell carcinoma with hormone and target treatment. Her blood oxygen saturation dropped to 92% during the operation, and pneumothorax was detected by ultrasound. O2 inhalation and lung dilation were performed. Her vital signs were monitored closely throughout the operation. The operation was accomplished, and she regained consciousness smoothly. A postoperative bedside chest X-ray was conducted after she was transferred to the urosurgery ward, while no evidence of further pneumothorax or lib injury was observed.

CONCLUSION

Pneumothorax is a severe complication in laparoscopic or robotic-assisted laparoscopic operations, especially in retroperitoneal ones. It is easily neglected unless the injury of the diaphragm is found. Low insufflation pressure and shorter operation time are necessary for patients with a history of long-term hormone consumption or chronic immune system disease.

Keywords: Pneumothorax; Laparoscopic partial nephrectomy; Lupus nephritis; Case report

Core Tip: Controlling the gas pressure in the abdomen or retroperitoneum is an essential issue in laparoscopic operations. High gas pressure may lead to the injury of the diaphragm and, thereafter, pneumothorax. This article presents a case with accidental pneumothorax during the operation. The novelties are: First, this patient may be at high risk of pneumothorax due to long-term hormone application, and this article could arouse everyone's attention to this issue by sharing a clinical example; second, our early recognition and quick reaction to the pneumothorax could provide precious data for peers. Overall, this case should have enlightening significance for managing surgical patients with long-term application of hormones.