Case Report Unusual cause of pneumomediastinum in a laparoscopic extraperitoneal inguinal hernia repair

Pneumomediastinum is an extremely rare complication after laparoscopic inguinal hernia repair. Very few cases have been reported in the surgical literature to date and most reports in-dicate pneumoperitoneum from the transabdominal preperitoneal approach as a causative factor. This case report describes a patient in whom an elective total extraperitoneal inguinal hernia repair was complicated by a pneumomediastinum without concomitant pneumoperito-neum, and identifies the tracking of air along the anterior extraperitoneal space and endothor-acic fascia as a cause. Previous case reports were reviewed and possible etiologies are discussed