ISSN: 0022-1198
CODEN: JFSCA
Page Count: 13

Fatal Carbon Dioxide Embolism Complicating Attempted Laparoscopic Cholecystectomy—Case Report and Literature Review
David Smith, J
Forensic Pathologist/Assistant Professor of Pathology; and Resident in Pathology, Bowman Gray/Baptist Hospital Medical Center, Wake Forest University, NC

Lantz, PE
Forensic Pathologist/Assistant Professor of Pathology; and Resident in Pathology, Bowman Gray/Baptist Hospital Medical Center, Wake Forest University, NC

(Received 4 March 1994; accepted 18 April 1994)

Abstract

Laparoscopic cholecystectomy has become the surgical procedure of choice for individuals with symptomatic gallbladder disease. The procedure has gained popularity among surgeons and patients because of inconspicuous abdominal incisions/scars, less postoperative pain, shorter hospitalization, and reduced medical costs. Bile duct, vascular, and gastrointestinal iatrogenic injuries are major complications.

We describe the case of a 50-year-old woman who died of CO² embolism during elective laparoscopic cholecystectomy for symptomatic cholelithiasis. With the patient under general anesthesia, a 1.5 cm incision was made just below the umbilicus, and a pneumoperitoneum was created by CO² insufflation with a pneumoperitoneum (modified Veress) needle. Immediately, she experienced a cardiopulmonary arrest and could not be resuscitated. At autopsy, air bubbles were admixed with blood in the epicardial veins and leptomeningeal blood vessels. A triangular 0.1 cm perforation in the left common iliac vein had been created by the pneumoperitoneum needle.

A pneumoperitoneum is required for laparoscopy and CO² is the most commonly used gas. Carbon dioxide is highly soluble in blood and fairly innocuous to the peritoneum. Small amounts absorbed into the circulation cause slight increases in arterial and alveolar CO² and in central venous pressure. When CO² enters the venous circulation through iatrogenically opened vascular channels, catastrophic and potentially fatal hemodynamic and respiratory compromise may result.

Keywords:
pathology and biology, carbon dioxide embolism, laparoscopic cholecystectomy, surgical complication

Paper ID: JFS13733J
DOI: 10.1520/JFS13733J
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