Case Report Diffuse Subcutaneous Emphysema, Pneumomediastinum, and Pneumothorax following Robotic Assisted Laparoscopic Hysterectomy Laryssa Patti, 1 William Haussner, 2 and Grant Wei 1 1 Rutgers Robert Wood Johnson Medical School, Department of Emergency Medicine, 1 RWJ Place, MEB 104, New Brunswick, NJ 08901, USA 2 Rutgers Robert Wood Johnson Medical School, 675 Hoes Lane, Piscataway, NJ 08854, USA Correspondence should be addressed to Laryssa Patti; pattila@rwjms.rutgers.edu Received 2 July 2017; Accepted 12 September 2017; Published 12 October 2017 Academic Editor: Oludayo A. Sowande Copyright © 2017 Laryssa Patti et al. Tis 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. Robotic assisted laparoscopic surgery is becoming more widely available, but despite its multiple benefts, it is not without risk. Tis case is of a 62-year-old female who presented to the emergency department for dyspnea two days afer robotic assisted laparoscopic hysterectomy. Physical exam revealed difuse facial, neck, upper extremity, torso, and lower extremity crepitus, which was diagnosed as difuse subcutaneous air on computed tomography (CT). Imaging also revealed right apical pneumothorax and pneumomediastinum. Te patient progressively improved over one month, with resolution of symptoms. 1. Introduction Robotic laparoscopic surgery is currently widely performed in both abdominal and gynecologic surgery, as it provides better access and visualization to surgical sites, especially those of the retroperitoneum [1]. Typically, the frst step in laparoscopic surgery is to enter the abdomen and insufate it with gas to allow for visualization of structures and space for surgical manipulation [2]. Traditionally, carbon dioxide (CO 2 ) is used for insufation because it is absorbed faster than air and thus allows for rapid insufation and desufation. It is also associated with decreased postoperative abdominal pain and distention as compared to air [3]. A rare but concerning complication of carbon dioxide insufation is subcutaneous emphysema [4]. Although some studies state that this risk is minimal [3], others have shown that longer intraoperative times and prolonged insufation of the peritoneum can increase incidence of this complication [4] and that retained carbon dioxide postoperatively can alter acid-base dynamics and cause cardiopulmonary collapse, especially in patients with decreased cardiac, pulmonary, or renal function [2]. 2. Case Tis patient is a 62-year-old female who presented to the emergency department (ED) for chest pain two days follow- ing robotic assisted laparoscopic supracervical hysterectomy with sacral colpopexy for a history of uterovaginal prolapse. Per operative report, surgery was prolonged due to incom- plete instrument count at the end of the surgery, requiring X-ray to retrieve the missing instrument. On postoperative day one, the patient had an intraoperatively placed Foley catheter removed, passed fatus, and tolerated liquids. She was discharged on that day with oral pain medication and a bowel regimen. In the emergency department, the patient described chest pain as substernal, pleuritic, and radiating to both shoulders. Chest pain was associated with mild dyspnea that was exac- erbated by exertion. She reported a “crunching” sensation in her skin on her torso and neck. Her only past medical history beyond the uterovaginal prolapse was a history of osteoporosis treated with raloxifene. Her vital signs at triage were oral temperature 36.8 degrees Celsius, pulse 91 beats per minute, respiratory rate Hindawi Case Reports in Emergency Medicine Volume 2017, Article ID 2674216, 3 pages https://doi.org/10.1155/2017/2674216