# Persistent pneumothorax after laparoscopic appendectomy in a patient who had undergone radical esophagectomy 5 years before: possible relationship with vulnerability of the hiatus after esophagectomy: a case report

## TL;DR

A patient with a history of esophagectomy developed a persistent pneumothorax after laparoscopic surgery, possibly due to anatomical vulnerability.

## Contribution

Highlights a possible link between prior esophagectomy and increased risk of pneumothorax after laparoscopic procedures.

## Key findings

- A patient with a history of esophagectomy developed a persistent pneumothorax after laparoscopic appendectomy.
- The pneumothorax resolved spontaneously after more than three days.
- The anatomical vulnerability from prior surgery may allow air migration into the thoracic cavity.

## Abstract

Postoperative pneumothorax is a well-known but relatively rare complication after laparoscopic surgery. Herein, we report a case of persistent pneumothorax after laparoscopic appendectomy. A 57-year-old male, with a history of minimally invasive esophagectomy and intrathoracic gastric tube reconstruction 5 years before, underwent a laparoscopic appendectomy. A chest X-ray taken on postoperative Day 1 revealed the development of the right pneumothorax, which took more than 3 days to resolve spontaneously. Although the mechanism of postoperative pneumothorax was unclear, it seemed likely that the air that had replaced carbon dioxide in the peritoneal cavity migrated into the thoracic cavity through the esophageal hiatus, which was not covered by the peritoneum or pleura after surgical resection. The present case, together with our previous similar case, suggests that a history of esophageal cancer surgery per se increases the risk of pneumothorax after laparoscopic surgery, probably regardless of when this was performed.