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Case Reports
. 2024 Jun 14;103(24):e38468.
doi: 10.1097/MD.0000000000038468.

A portent of catastrophic carbon dioxide embolism in laparoscopic hepatectomy: A case report

Mei Li  1 , Bing Yan  1   2 , Mi Wang  1 , Shengmei Zhu  1 , Xianhui Kang  1
Affiliations
Case Reports

A portent of catastrophic carbon dioxide embolism in laparoscopic hepatectomy: A case report

Mei Li et al. Medicine (Baltimore). .

Abstract

Introduction: Laparoscopic hepatectomy (LH) poses a high risk of carbon dioxide embolism due to extensive hepatic transection, long surgery duration, and dissection of the large hepatic veins or vena cava.

Patient concerns: A 65-year-old man was scheduled to undergo LH. Following intraperitoneal carbon dioxide (CO2) insufflation and hepatic portal occlusion, the patient developed severe hemodynamic collapse accompanied by a decrease in the pulse oxygen saturation (SpO2).

Diagnosis: Although a decrease in end-tidal carbon dioxide (ETCO2) was not observed, CO2 embolism was still suspected because of the symptoms.

Interventions and outcomes: The patient was successfully resuscitated after the immediate discontinuation of CO2 insufflation and inotrope administration. CO2 embolism must always be suspected during laparoscopic surgery whenever sudden hemodynamic collapse associated with decreased pulse oxygen saturation occurs, regardless of whether ETCO2 changes. Instant arterial blood gas analysis is imperative, and a significant difference between PaCO2 and ETCO2 is indicative of carbon dioxide embolism.

Conclusion: Instant arterial blood gas analysis is imperative, and a significant difference between PaCO2 and ETCO2 is indicative of carbon dioxide embolism.

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Conflict of interest statement

The authors have no funding and conflicts of interest to disclose.

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References

    1. Cottin V, Delafosse B, Viale JP. Gas embolism during laparoscopy. Surg Endosc. 1996;10:166–9. - PubMed
    1. Nakagawa R, Nohara T, Kadomoto S, et al. . Carbon dioxide gas embolism during robot-assisted laparoscopic partial nephrectomy. IJU Case Rep. 2022;5:334–7. - PMC - PubMed
    1. Kawahara T, Hagiwara M, Takahashi H, et al. . Cerebral Infarction by paradoxical gas embolism during laparoscopic liver resection with injury of the hepatic vessels in a patient without a right-to-left systemic shunt. Am J Case Rep. 2017;18:687–91. - PMC - PubMed
    1. Otsuka Y, Katagiri T, Ishii J, et al. . Gas embolism in laparoscopic hepatectomy: what is the optimal pneumoperitoneal pressure for laparoscopic major hepatectomy? J Hepatobiliary Pancreat Sci. 2013;20:137–40. - PubMed
    1. Huntington CR, Prince J, Hazelbaker K, et al. . Safety first: significant risk of air embolism in laparoscopic gasketless insufflation systems. Surg Endosc. 2019;33:3964–9. - PubMed

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