Pericarditis as a Result of Pneumomediastinum after Uncomplicated Laparoscopic Totally Extraperitoneal Inguinal Hernia Repair

摘要

A 25-year-old man with symptomatic, bilateral inguinal hernias was taken to the operating room for laparoscopic, totally extraperitoneal inguinal hernia repair. The operation was uncomplicated and the peritoneum was not entered. The patient was discharged home the same day. He returned to the emergency department the following day with sudden onset of dyspnea and substernal chest pain. A chest X-ray was obtained and was remarkable for pneumomediastinum and subcutaneous emphysema. An electrocardiogram (ECG) was done and showed diffuse, noncontiguous ST-segment elevations (Fig. 1). Computed tomography of the chest done with oral contrast showed no evidence of esophageal perforation or tracheal injury and confirmed the presence of pneumomediastinum (Fig. 2). Cardiology consultation was obtained. His symptoms and ECG changes were felt to be caused by pericardial irritation from pneumomediastinum. and he was treated with a two-week course of ibuprofen at their recommendation. At follow-up in general surgery clinic, his chest pain had resolved and repeat ECG testing was normal.