{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T16:42:50Z","timestamp":1787071370657,"version":"build-2736575974"},"reference-count":15,"publisher":"Ovid Technologies (Wolters Kluwer Health)","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"Abstract<\/jats:title>\n \n Capnothorax is a rare but potentially serious complication of laparoscopic surgery, typically attributed to diaphragmatic injury or retroperitoneal CO\n 2<\/jats:sub>\n tracking. We report a case of intraoperative capnothorax in a 52-year-old woman undergoing laparoscopic common bile duct exploration. Two hours after pneumoperitoneum establishment (13\u201314 mmHg), the patient developed acute right-sided pneumothorax, presenting as a sudden increase in peak airway pressure (28 cm H\n 2<\/jats:sub>\n O) with stable end-tidal CO\n 2 (<\/jats:sub>\n 36 mmHg). Intraoperative inspection and post-operative computed tomography excluded structural diaphragmatic defects, implicating transdiaphragmatic CO\n 2<\/jats:sub>\n diffusion through a congenitally weakened diaphragm. Conservative management \u2013 including reduction of pneumoperitoneum pressure to 10 mmHg, application of 5 cm H\n 2<\/jats:sub>\n O positive end-expiratory pressure and real-time lung ultrasound \u2013 confirmed the diagnosis (stratosphere sign and lung point) and achieved resolution within 40 min without thoracic drainage or surgical interruption. This case highlights congenital diaphragmatic weakness as an under-recognised aetiology of capnothorax and supports a physiologically guided, non-invasive approach that challenges traditional protocols favouring emergent thoracostomy.\n <\/jats:p>","DOI":"10.4103\/jmas.jmas_348_25","type":"journal-article","created":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T18:00:11Z","timestamp":1775584811000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Congenital diaphragmatic weakness as a cause of capnothorax during laparoscopic surgery: A case report and management insights"],"prefix":"10.4103","author":[{"given":"Lu","family":"Li","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,4,7]]},"reference":[{"key":"R1-20260407","doi-asserted-by":"crossref","first-page":"1445","DOI":"10.1089\/end.2007.0122","article-title":"Case report: Conservative management of a large capnothorax following laparoscopic renal surgery","volume":"21","author":"Msezane","year":"2007","journal-title":"J Endourol"},{"key":"R2-20260407","doi-asserted-by":"crossref","first-page":"385","DOI":"10.4103\/jmas.JMAS_34_21","article-title":"Pneumothorax as a rare complication during laparoscopic total extra-peritoneal inguinal hernia repair: A case report and review of the literature","volume":"17","author":"Koliakos","year":"2021","journal-title":"J Minim Access Surg"},{"key":"R3-20260407","doi-asserted-by":"crossref","first-page":"807","DOI":"10.1089\/end.2021.0336","article-title":"The effect of CO (2) pressure and flow variation on carbon particles spread during pneumoperitoneum: An experimental study","volume":"36","author":"Gallioli","year":"2022","journal-title":"J Endourol"},{"key":"R4-20260407","first-page":"1","article-title":"Impact of standard versus low pneumoperitoneum pressure on peritoneal environment in laparoscopic cholecystectomy","volume":"34","author":"Serrano","year":"2024","journal-title":"Randomized clinical trial. 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