[Iatrogenic gas embolism after use of hydrogen peroxide in the treatment of lung hydatid cyst: a report of 2 cases].
BACKGROUND
Echinococcus disease is endemic in our country. Surgical resection of the hydatid cyst with the use of a protoscolicidal solution in the operative field remains the standard treatment. The degradation of hydrogen peroxide results in considerable amounts of gaseous oxygen witch has proven protoscolicidal properties. This gas can enter the circulation and determine severe embolism.


OBJECTIVE
We report two cases of severe oxygen embolism with neurological signs during surgical treatment of thoracic hydatid cysts.


METHODS
We report 2 cases of embolic events with neurological signs. The first, during a pleural cleaning with hydrogen peroxide after cystectomy of a pulmonary hydatic cyst at the right upper lobe. The second case, after a pleural washing during the treatment of hepatitic hydatidosis complicated by a ruptured cyst in the thorax.


CONCLUSIONS
The most important diagnostic criterion is the patient's history, because the clinical suspicion of embolism is based on the initial neurologic or cardio-respiratory symptoms and the direct relation between these symptoms and the use of hydrogen peroxide and imposes appropriate treatment before further examination including brain imaging. The treatment with hyperbaric oxygen is the first line treatment, thus, transfer to a hyperbaric oxygen facility should be accomplished without delay. The possibility of such serious complication leads us to use hydrogen peroxide with great care or to use other protoscolicidal solutions.
Service de chirurgie thoracique et cardiovasculaire de l'hôpital Abderrahmen Mami, Ariana.
Sonia
S
Ouerghi
Khoubeib
K
Abdelhafidh
Adel
A
Merghli
Belhassen
B
Smati
Mohamed Sadok
MS
Boudaya
Khaled
K
Lamine
Taher
T
Mestiri
Tarek
T
Kilani
D000328:Adult; D000891:Anti-Infective Agents, Local / Q000009:adverse effects*; D004445:Echinococcosis, Pulmonary / Q000601:surgery*; D004618:Embolism, Air / Q000139:chemically induced*; D005260:Female; D006801:Humans; D006861:Hydrogen Peroxide / Q000009:adverse effects*; D007049:Iatrogenic Disease; D007431:Intraoperative Complications; D008297:Male; D007507:Therapeutic Irrigation
D000891:Anti-Infective Agents, Local; D006861:Hydrogen Peroxide