Massive Carbon Dioxide Embolism during Pneumoperitoneum for Laparoscopic Adrenalectomy

Hsiao Chun Teng, Huei Ming Yeh*, So Mong Wang and Nai Hsin Chi

A 65-year-old man, with suspected right adrenal metastasis from hepatic carcinoma, was scheduled to undergo a laparoscopic right adrenalectomy. About 75 minutes into the operation, when attempting to remove the adrenal gland that was tightly adhesive to the inferior vena cava (IVC), the surgeon accidently nicked the inferior vena cava which resulted in a large tear of about 2 x 2 cm. Considering the difficulty of  performing  exploratory  laparotomy  due  to  previous  hepatic  tumor  excision  related  intra-abdominal  adhesion,  the  surgeon  tried  to  sow  the  torn  IVC  through  the  use  of  the  laparoscope  and  to  control  the bleeding via carbon dioxide (CO2) insufflation pressure. This resulted in a massive amount of gas entering the vessel via the IVC broken hole. When we performed a transesophageal chocardiography (TEE), it was revealed that the right atrium and right ventricle were totally white out because they were full of air. About 20 minutes after the IVC tear, the TEE image also revealed that the left heart also contained scattered air embolisms.  The  surgeon  spent  about  60  minutes  on  repairing  the  IVC  tear.  Blood  pressure  was  stable during the IVC tear insult but dropped slightly after the IVC tear repaired. Low dose norepinephrine and dopamine  continuous  infusion  were  administered  to  stabilize  the  patient’s  blood  pressure.  After  the operation,  the  patient  presented  mild  weakness  in  his  left  limbs.  Fortunately,  the  symptoms  dissipated two days after the surgery. 12 days later, the patient was discharged without any neurologic sequelae.

Keywords:

Published on: Jul 6, 2017 Pages: 38-40

Full Text PDF Full Text HTML DOI: 10.17352/2455-5495.000025
CrossMark Publons Harvard Library HOLLIS Search IT Semantic Scholar Get Citation Base Search Scilit OAI-PMH ResearchGate Academic Microsoft GrowKudos Universite de Paris UW Libraries SJSU King Library SJSU King Library NUS Library McGill DET KGL BIBLiOTEK JCU Discovery Universidad De Lima WorldCat VU on WorldCat