CARBON-DIOXIDE EMBOLISM COMPLICATING ATTEMPTED LAPAROSCOPIC CHOLECYSTECTOMY - CASE-REPORT AND LITERATURE-REVIEW

Laparoscopic cholecystectomy has become the surgical procedure of choi ce for individuals with symptomatic gallbladder disease. The procedure has gained popularity among surgeons and patients because of inconspi cuous abdominal incisions/scars, less postoperative pain, shorter hosp italization, and reduced medical costs. Bile duct, vascular, and gastr ointestinal iatrogenic injuries are major complications. We describe t he case of a 50-year-old woman who died of CO2 embolism during electiv e laparoscopic cholecystectomy for symptomatic cholelithiasis. With th e patient under general anesthesia, a 1.5 cm incision was made just be low the umbilicus, and a pneumoperitoneum was created by CO2 insufflat ion with a pneumoperitoneum (modified Veress) needle. Immediately, she experienced a cardiopulmonary arrest and could not be resuscitated. A t autopsy, air bubbles were admired with blood in the epicardial veins and leptomeningeal blood vessels. A triangular 0.1 cm perforation in the left common iliac vein had been created by the pneumoperitoneum ne edle. A pneumoperitoneum is required for laparoscopy and CO2 is the mo st commonly used gas. Carbon dioxide is highly soluble in blood and fa irly innocuous to the peritoneum. Small amounts absorbed into the circ ulation cause slight increases in arterial and alveolar CO2 and in cen tral venous pressure. When CO2 enters the venous circulation through i atrogenically opened vascular channels, catastrophic and potentially f atal hemodynamic and respiratory compromise may result.