Pneumothorax during retroperitoneal laparoscopic partial nephrectomy in a lupus nephritis patient: A case report

Background: Downgrading target treatment and laparoscopic partial nephrectomy have become increasingly popular in patients with renal cell carcinomas. Rare as it is, pneumothorax is one of the most severe intraoperative complications which needs immediate recognition. On the other hand, as a rheumatological disease, lupus nephritis requires a long period of hormone therapy. Cases of pneumothorax in hormone-consuming renal cancer patients are even fewer.

Case summary: A 39-year-old woman was admitted to our department to take a laparoscopic partial nephrectomy. The patient had a medical history of lupus nephritis and renal clear cell carcinoma with hormone and target treatment. Her blood oxygen saturation dropped to 92% during the operation, and pneumothorax was detected by ultrasound. O₂ inhalation and lung dilation were performed. Her vital signs were monitored closely throughout the operation. The operation was accomplished, and she regained consciousness smoothly. A postoperative bedside chest X-ray was conducted after she was transferred to the urosurgery ward, while no evidence of further pneumothorax or lib injury was observed.

Conclusion: Pneumothorax is a severe complication in laparoscopic or robotic-assisted laparoscopic operations, especially in retroperitoneal ones. It is easily neglected unless the injury of the diaphragm is found. Low insufflation pressure and shorter operation time are necessary for patients with a history of long-term hormone consumption or chronic immune system disease.