Surgical emphysema and pneumothorax following open cholecystectomy under general anesthesia

We present a case of surgical emphysema and bilateral pneumothorax following open cholecystectomy under general anesthesia in a patient previously treated for lower respiratory infection. Pneumothorax following open cholecystectomy under general anesthesia is rare. The incidence is about 0.01–0.4%. Immediate recognition and prompt treatment is essential. A female patient with history of treated lower respiratory tract infection 6 weeks before surgery posted for open cholecystectomy. Induction/maintenance phase was uneventful. At the time of extubation, surgical emphysema was noticed in the chest, neck, and face. Airway pressures and vitals were normal. Chest radiograph confirmed pneumothorax, which was promptly treated. Pneumothorax following general anesthesia is due to injury to the pleura or rupture of intrapulmonary alveoli. The probable precipitating cause in our patient could be because of previous history of lower respiratory tract infection, intermittent positive-pressure ventilation, and nitrous oxide. High index of suspicion is required to diagnose pneumothorax in a patient with surgical emphysema with stable vital data and normal airway pressures.