title: Gas embolism during laparoscopic cholecystectomy.
abstract: Advancements in laparoscopic surgery have resulted in decreased length of hospitalization, reduced postoperative pain, and better cosmesis following general surgical procedures. Carbon dioxide gas embolism is a rare occurrence that can be fatal. We report the case of a patient with a venous gas embolism during laparoscopic cholecystectomy. A 63-year-old woman presented with intermittent right upper quadrant pain, and her abdominal ultrasound showed a possible gallbladder polyp. A laparoscopic cholecystectomy was planned. A Veress needle was placed in the right upper quadrant to initiate abdominal access. Shortly after carbon dioxide insufflation, the patient's hemodynamic status deteriorated, her oxygen saturation dropped, and her end-tidal CO2 decreased. Gas insufflation was immediately stopped, and the patient was resuscitated. She stabilized quickly, and the procedure was performed without further event. She did well postoperatively and was discharged home the next day. Carbon dioxide embolism during laparoscopy, albeit rare, can be a fatal complication of the procedure. Whenever sudden changes in hemodynamic stability occur, venous gas embolism should be considered. As laparoscopic techniques and applications are expanded, the general surgeon must be aware of this entity.
authors.affiliation: Carolinas Laparoscopic and Advanced Surgery Program, Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina 28203, USA.
authors.forename: William S
authors.initials: WS
authors.lastname: Cobb
authors.forename: Henry A
authors.initials: HA
authors.lastname: Fleishman
authors.forename: Kent W
authors.initials: KW
authors.lastname: Kercher
authors.forename: Brent D
authors.initials: BD
authors.lastname: Matthews
authors.forename: B Todd
authors.initials: BT
authors.lastname: Heniford
mesh_terms: D002245:Carbon Dioxide; D017081:Cholecystectomy, Laparoscopic; D004618:Embolism, Air / Q000209:etiology*; D005260:Female; D006801:Humans; D007327:Insufflation / Q000009:adverse effects*; D008875:Middle Aged
chemical_list: D002245:Carbon Dioxide