Massive Subcutaneous Emphysema Involving the Head and Neck After Laparoscopic Roux-en-Y Gastric By-pass

Massive and life-threatening extraperitoneal pneumodissection after laparoscopic procedure is a rare complication. It has been described after laparoscopic cholecystectomy, urologic and gynecologic surgeries, extraperitoneal hernia, and antireflux procedures. Here, we describe such a complication after laparoscopic Roux–en-Y gastric bypass in a 21-year-old woman with a body mass index of 41. Postoperatively, massive subcutaneous emphysema, fever, anxiety, and hypoxia occurred. She required reintubation and mechanical ventilation for two days. She was weaned from the mechanical ventilator and subcutaneous emphysema decreased gradually. Duration of her hospitalization was seven days, after which she was discharged uneventfully. Diagnosis of the surgical complications in the early postoperative period is not easy but vital after bariatric surgery. In obese patients, it is difficult to realize the swelling on the trunk when compared to thin patients. Fascial and neck swelling can indicate the severity of the pneumodissection. In such cases, pharyngo-esophageal perforations due to difficult endotracheal intubations in obese patients or trauma during per oral passage of the stapler anvil should be kept in mind and ruled out immediately. To our knowledge, this is the first documented case of massive subcutaneous emphysema involving the neck and face after laparoscopic gastric bypass.