• Keita Hazama, Yuichiro Toda, Hideki Nakatsuka, and Yoshihisa Fujita.
• From the Department of Anesthesiology and Intensive Care Medicine, Kawasaki Medical School, Kurashiki, Japan.
• A A Pract. 2019 Jan 15; 12 (2): 33-36.

AbstractThere are various causes of dysfunction of the diaphragm. We present a case of diaphragm dysfunction caused by an excessive pneumoperitoneum in a 65-year-old woman. Her abdomen became distended during endoscopic investigation and circulatory failure occurred. A computed tomography scan revealed excessive pneumoperitoneum. Urgent laparotomy was performed to repair gastric perforation. Tracheal extubation was successfully performed in the intensive care unit. After extubation, a paradoxical breathing pattern appeared in addition to tachypnea. A diagnosis of dysfunction of the bilateral diaphragm was made by ultrasonography. Although nasal high-flow cannula therapy was required for several days, she was discharged from our hospital 2 weeks after surgery without any further complications. We should keep in mind that diaphragm dysfunction after excessive abdominal extension can be a cause of respiratory failure.

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