[Lesional pulmonary oedema following laparoscopy for haemorrhage: aetiological assessment and possible gas embolism].
A 44-year-old woman had to undergo repeat laparoscopy, four hours after laparoscopic sigmoidectomy, because of persistent bleeding from the drain. The bleeding caused perioperative shock and necessitated transfusional support. The following day she developed dyspnea, revealing pulmonary oedema. As her respiratory status continued to deteriorate and the bleeding persisted, she was transferred to the intensive care unit on day 2, after corrective laparotomy. The echocardiogram ruled out cardiogenic pulmonary oedema. No inhalation had occurred during the three anaesthetic procedures, and onset several hours after transfusion argued against lesional pulmonary oedema secondary to packed red cell transfusion. Given the context of repeat surgery by laparoscopy because of active bleeding, a diagnosis of lesional pulmonary oedema complicating CO(2) embolism was made. She received symptomatic treatment and her respiratory status gradually improved. Four months later her clinical status was normal. The different causes of postoperative pulmonary oedema and the pathophysiologic mechanisms of pulmonary lesions induced by gas embolism are discussed.
Cuvelier
A
A
Service de Réanimation Polyvalente, Hôpital Girac, Centre Hospitalier d'Angoulême, 16470 Saint-Michel, France.
Calvat
S
S
Longuet
O
O
Desachy
A
A
D000328:Adult; D001803:Blood Transfusion; D013505:Digestive System Surgical Procedures; D004562:Electrocardiography; D004618:Embolism, Air / Q000209:etiology* / Q000473:pathology; D005260:Female; D006470:Hemorrhage / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D007813:Laparotomy; D011654:Pulmonary Edema / Q000209:etiology*; D012769:Shock / Q000209:etiology