{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T16:21:41Z","timestamp":1788538901386,"version":"build-2803163510"},"reference-count":13,"publisher":"Ovid Technologies (Wolters Kluwer Health)","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Subcutaneous emphysema (SE) is a rare and usually self-limiting complication of laparoscopic totally extraperitoneal (TEP) inguinal hernia repair. We report a 74-year-old man who developed massive SE after a short, technically uncomplicated 32-min TEP repair, despite the absence of major modifiable technical risk factors \u2013 working pressure \u226412 mmHg, open (Hasson) entry, single absorbable tack and no peritoneal breach. An abrupt rise in end-tidal carbon dioxide (EtCO\n                    <jats:sub>2<\/jats:sub>\n                    ) from a stable baseline (34\u201336 mmHg) to 60 mmHg was the earliest warning sign and preceded clinical detection. Post-operative computed tomography revealed SE extending to the neck, thorax, abdominal wall, back and both upper and lower extremities, surpassing all categories of the Aghajanzadeh classification. The patient was managed conservatively with manual decompression and an intentionally open trocar site, with complete resolution. This case illustrates an anatomical distribution extending beyond the territories included in conventional SE grading and underscores EtCO\n                    <jats:sub>2<\/jats:sub>\n                    monitoring as a valuable early warning tool.\n                  <\/jats:p>","DOI":"10.4103\/jmas.jmas_273_26","type":"journal-article","created":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T16:00:52Z","timestamp":1788537652000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Subcutaneous emphysema beyond conventional grading following uncomplicated totally extraperitoneal inguinal hernia repair: A case report"],"prefix":"10.4103","author":[{"given":"Abdullah G\u00fcrhan","family":"Duyan","sequence":"first","affiliation":[{"name":"Department of General Surgery, Faculty of Medicine, Sel\u00e7uk University, Konya, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammed Nezih","family":"Ko\u00e7","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Reanimation, Konya City Hospital, Konya, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,9,3]]},"reference":[{"key":"R1-20260904","doi-asserted-by":"crossref","first-page":"1047","DOI":"10.1007\/s10029-023-02785-0","article-title":"Comparison of bilateral to unilateral total extra-peritoneal (TEP) inguinal hernia repair: A systematic review and meta-analysis","volume":"27","author":"Hitman","year":"2023","journal-title":"Hernia"},{"key":"R2-20260904","doi-asserted-by":"crossref","first-page":"1969","DOI":"10.1007\/s00464-024-10701-5","article-title":"Subcutaneous emphysema associated with laparoscopic or robotic abdominal surgery: A retrospective single-center study","volume":"38","author":"Ito","year":"2024","journal-title":"Surg Endosc"},{"key":"R3-20260904","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1089\/lap.2007.0089","article-title":"Factors influencing development of subcutaneous carbon dioxide emphysema in laparoscopic totally extraperitoneal inguinal hernia repair","volume":"18","author":"Saggar","year":"2008","journal-title":"J Laparoendosc Adv Surg Tech A"},{"key":"R4-20260904","first-page":"704","article-title":"Risk factors for hypercarbia, subcutaneous emphysema, pneumothorax, and pneumomediastinum during laparoscopy","volume":"95","author":"Murdock","year":"2000","journal-title":"Obstet Gynecol"},{"key":"R5-20260904","first-page":"3810","article-title":"Subcutaneous emphysema and hypercarbia during laparoscopic surgery: Mechanisms, risk factors, and management","volume":"31","author":"Moris","year":"2017","journal-title":"Surg Endosc"},{"key":"R6-20260904","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1186\/s12871-026-03686-2","article-title":"Incidence, risk factors, and clinical impact of subcutaneous emphysema following laparoscopic totally extraperitoneal inguinal herniorrhaphy: A retrospective cohort study","volume":"26","author":"Chung","year":"2026","journal-title":"BMC Anesthesiol"},{"key":"R7-20260904","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1007\/s12630-024-02859-2","article-title":"Incidence, outcomes, and risk factors of postlaparoscopic subcutaneous emphysema: A historical cohort study","volume":"72","author":"Onitsuka","year":"2025","journal-title":"Can J Anaesth"},{"key":"R8-20260904","first-page":"161","article-title":"Incidence of severe subcutaneous emphysema after robotic versus conventional laparoscopic surgery: A retrospective single-center study","volume":"11","author":"Komatsu","year":"2025","journal-title":"Fujita Med J"},{"key":"R9-20260904","first-page":"e31816","article-title":"Extensive subcutaneous emphysema associated with pneumothorax, pneumomediastinum, and pneumoperitoneum: A case report","volume":"14","author":"Robinson","year":"2022","journal-title":"Cureus"},{"key":"R10-20260904","doi-asserted-by":"crossref","first-page":"rjad146","DOI":"10.1093\/jscr\/rjad146","article-title":"Pneumomediastinum and pneumothorax: A rare complication of laparoscopic total extraperitoneal inguinal hernia repair","volume":"2023","author":"Wallace","year":"2023","journal-title":"J Surg Case Rep"},{"key":"R11-20260904","doi-asserted-by":"crossref","first-page":"759","DOI":"10.1007\/s13244-013-0278-0","article-title":"The anatomical compartments and their connections as demonstrated by ectopic air","volume":"4","author":"Frias","year":"2013","journal-title":"Insights Imaging"},{"key":"R12-20260904","doi-asserted-by":"crossref","first-page":"673","DOI":"10.1007\/s12262-013-0975-4","article-title":"Classification and management of subcutaneous emphysema: A 10-year experience","volume":"77","author":"Aghajanzadeh","year":"2015","journal-title":"Indian J 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