title: Carbon dioxide embolism during laparoscopic cholecystectomy due to a patent paraumbilical vein.
abstract: Carbon dioxide embolism is a rare but potentially fatal complication of laparoscopic surgery. The most common cause is inadvertent injection of carbon dioxide into a large vein or solid organ during initial peritoneal insufflation. We describe a case of carbon dioxide embolism in a 13-year-old boy during an elective laparoscopic cholecystectomy, caused by injection of carbon dioxide into a large paraumbilical vein. The clinical manifestations of carbon dioxide embolism were hypotension, bradycardia, and an abrupt drop in end-tidal CO2. He subsequently did well and had no sequelae. Carbon dioxide embolism is a recognized complication of laparoscopic surgery, although the risk to the patient may be minimized by the surgical team's awareness of the problem, continuous intraoperative monitoring of end-tidal CO2, and using an open technique for initial access to the peritoneum.
authors.affiliation: Pediatric General, Thoracic and Fetal Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA. mattei@email.chop.edu
authors.forename: Peter
authors.initials: P
authors.lastname: Mattei
authors.forename: Donald C
authors.initials: DC
authors.lastname: Tyler
mesh_terms: D000293:Adolescent; D002245:Carbon Dioxide / Q000009:adverse effects*; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D004618:Embolism, Air / Q000209:etiology*; D042882:Gallstones / Q000601:surgery; D006801:Humans; D007267:Injections / Q000009:adverse effects; D007327:Insufflation / Q000009:adverse effects*; D008297:Male; D011028:Pneumoperitoneum, Artificial / Q000009:adverse effects / Q000295:instrumentation; D014471:Umbilical Veins / Q000002:abnormalities*
chemical_list: D002245:Carbon Dioxide