Acute Intraoperative Tension Pneumothorax after Reduction of a Traumatic Diaphragmatic Hernia During Laparoscopic Repair

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Authors

• Nicholas Mulder, Michigan State University College of Human Medicine Medical Student
• Ken Dada, Michigan State University College of Human Medicine Medical Student
• Alex Finn, Corewell Health West Resident
• Nicholas Watson, Corewell Health West

Description

Traumatic diaphragmatic rupture can lead to pneumothorax if repaired laparoscopically. Herniation of abdominal viscera into the thorax may occlude communication between pleura and peritoneum at the site of trauma. Manipulation of the herniated tissue may lead to hemodynamic instability until the hernia is reduced and thoracoabdominal communication equalizes pressure.

A hemodynamically stable 92 year old male with traumatic diaphragmatic rupture and herniated colon into the thoracic cavity underwent robotic assisted laparoscopic reduction of the colon from the chest and repair of the diaphragmatic hernia. He was breathing spontaneously on supplemental oxygen preoperatively with adequate oxygenation. Intraoperatively the patient's abdomen was insufflated, he was ventilated with positive pressure, and remained hemodynamically stable. He was placed in steep reverse Trendelenburg to assist in visualization. The patient became hypotensive during attempted reduction of the herniated colon.  Multiple vasoactive medications were given without significant effect, auscultation demonstrated absent left-sided breath sounds, and tension pneumothorax was suspected. Abdominal insufflation was immediately discontinued and a left chest tube was placed with return of stable blood pressure. The colon was then able to be reduced and the diaphragm repaired.

In patients with chest trauma and diaphragmatic rupture with herniated viscus, preoperative stability does not exclude pleural vulnerability when performing laparoscopic repair with abdominal insufflation. Manipulation of herniated tissue may act as a one-way valve during repair and may precipitate tension pneumothorax; prompt recognition, cessation of insufflation, and emergent pleural decompression are critical in this setting. In such cases thoracic decompression prior to insufflation with a thoracostomy tube is prudent.

Publication Date

5-8-2026

Disciplines

Surgery

Recommended Citation

Mulder N, Dada K, Finn A, Watson N. Acute intraoperative tension pneumothorax after reduction of a traumatic diaphragmatic hernia during laparoscopic repair. Presented at: Research Day Corewell Health West; 2026 May 8; Grand Rapids, MI.

Comments

2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 2101