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Case Reports in Obstetrics and Gynecology
Volume 2015 (2015), Article ID 860719, 3 pages
http://dx.doi.org/10.1155/2015/860719
Case Report

Iatrogenic Lower Extremity Subcutaneous Emphysema after Prolonged Robotic-Assisted Hysterectomy

1Department of Obstetrics/Gynecology, The Ohio State University, 5th Floor, 395 West 12th Avenue, Columbus, OH 43210, USA
2The Mark H. Zangmeister Center, 3100 Plaza Properties Boulevard, Columbus, OH 43219, USA

Received 11 September 2015; Revised 29 November 2015; Accepted 2 December 2015

Academic Editor: Anna Fagotti

Copyright © 2015 Monica Hagan Vetter et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Subcutaneous emphysema is a known complication of carbon dioxide insufflation, an essential component of laparoscopy. The literature contains reports of hypercarbia, pneumothorax, or pneumomediastinum. However, isolated lower extremity subcutaneous emphysema remains a seldom-reported complication. We report a case of unilateral lower extremity subcutaneous emphysema following robotic-assisted hysterectomy, bilateral salpingooophorectomy, staging, and anterior/posterior colporrhaphy for carcinosarcoma and vaginal prolapse. On postoperative day 1, the patient developed tender crepitus and bruising of her right ankle. Radiography confirmed presence of subcutaneous air. Vital signs and laboratory findings were unremarkable. Her symptoms spontaneously improved over time, and she was discharged in good condition on day 2. In stable patients with postoperative extremity swelling or pain with crepitus on exam, the diagnosis of iatrogenic subcutaneous emphysema must be considered.