Anesth Pain Med.  2018 Jan;13(1):72-76. 10.17085/apm.2018.13.1.72.

Hypotension due to compression of the inferior vena cava by intrathoracic herniation of peritoneal fat during laparoscopic surgery: A case report

• Yun M
• Kim GH
• Lee SY
• Cho H
• Kim BU
• Koo MS
• Kwon MY

• KMID: 2436059
• DOI: http://doi.org/10.17085/apm.2018.13.1.72

Abstract

Vena cava syndrome is caused by central venous obstruction and can be divided into superior vena cava syndrome and inferior vena cava (IVC) syndrome. Symptoms and signs of IVC syndrome vary from no symptoms to lower limb edema, hypotension, and typical venous stasis changes of the lower extremities, such as brownish discoloration of the skin, woody edema, and ulceration. Carbon dioxide pneumoperitoneum, lithotomy-Trendelenburg position, and abdominal obesity could increase intra-abdominal pressure. We report a patient undergoing laparoscopic surgery who showed intrathoracic herniation of peritoneal fat induced by elevated intra-abdominal pressure due to the reasons mentioned above, resulting in IVC syndrome and hypotension perioperatively. The patient was treated with a conservative approach because he was asymptomatic except for hypotension on the first postoperative day.

Keyword

Inferior vena cava; Laparoscopy

MeSH Terms

Carbon Dioxide
Edema
Humans
Hypotension*
Laparoscopy*
Lower Extremity
Obesity, Abdominal
Pneumoperitoneum
Skin
Superior Vena Cava Syndrome
Ulcer
Vena Cava, Inferior*
Carbon Dioxide

Figure

• 

  Fig. 1 Intraoperative changes in vital signs. HR: heart rate, MAP: mean arterial blood pressure. *Intubation, †start of surgery (start of carbon dioxide pneumoperitoneum and lithotomy-Trendelenburg position), ‡start of dopamine continuous infusion.

• 

  Fig. 2 Preoperative axial abdomino-pelvic computed tomography scan at the T11 level, showing no compression of the inferior vena cava (arrow) or hepatic vein.

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  Fig. 3 Postoperative axial abdomino-pelvic computed tomography scan at the T11 level, showing peritoneal fat (asterisk) compressing the inferior vena cava (arrow).

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