A Case Report of Hammans Syndrome
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Hamman’s syndrome is the development of spontaneous pneumomediastinum and subcutaneous emphysema; it was first reported in 1939 by American physician Louis Hamman.

A 28-year-old primiparous woman with no significant past medical history, a normal BMI and a normal antenatal course presented to the birthing unit in early labor at 40+1. She progressed through the first stage of labor in 6 hours using nitrous oxide and water emersion for analgesia. There was significant vomiting during the active 1st stage of labor. Artificial rupture of membranes was performed due to maternal request at 8 cm. the Second stage lasted 115 mins; there was a single pull vacuum-assisted delivery of a well 3.7 kg baby in the lithotomy position due to maternal exhaustion. The third stage lasted 5 mins and was managed actively. She received 10 units IM syntocinon, as well as 250 mcg ergometrine IM due to uterine atony. There was a 400ml estimated blood loss given.

Twelve hours postpartum the patient described a ‘crackling’ sensation under her left jaw and ear. She was assessed by the resident doctor and found to have subcutaneous emphysema that could be felt localized to the left mandible and upper neck, no other significant signs or symptoms were noted. Due to the patients, hemodynamic stability no further investigations were ordered. Later that evening the patient began experiencing a sore throat and some difficulty swallowing. At this point, the patient was reviewed by the obstetric registrar who ordered a chest x-ray and commenced oxygen therapy. A chest x-ray revealed subcutaneous emphysema. The obstetric registrar discussed the case with an on-call cardiothoracic registrar and was advised to perform a CT scan with contrast. CT scan reported pneumomediastinum with subcutaneous gas. No pneumothorax or obvious oesophageal tear was noted. She initially received 24 hours of IV cefazolin to treat possible mediastinitis. The patient remained hemodynamically stable overnight with no progression of her symptoms. There was no suspicion of oesophageal rupture and so antibiotics were ceased. She continued to have conservative management on the ward and was discharged home on day 4 postpartum. By day 9 postpartum she reported complete resolution of her symptoms.

Source: https://gynecology-obstetrics.imedpub.com/a-report-of-two-cases-of-hammans-syndrome.php?aid=28224
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