Pneumoperitoneum complicated pneumomediastinum causing cardiovascular deterioration in a low-body-weight premature infant during laparoscopic Nissen fundoplication.

Due to smaller incisions, fewer wound injuries, and a shorter time of recovery, laparoscopic procedures are becoming increasingly popular in pediatric surgery, but the safety of their application in low-body-weight or premature infants should be a major concern. Here we present a case report of a 3-month-old premature infant, who developed a sudden change of hemodynamic instability while undergoing a laparoscopic Nissen's fundoplication for gastroesophageal reflex disease. This was thought to result from an accidental passage of massive insufflation of carbon dioxide gas across the diaphragm, leading to pneumomediastinum.