2026-06-09T20:30:22Z https://www.peertechzpublications.org/oai-pmh

oai:www.peertechzpublications.org:10.17352/2455-5495.000025 2017-07-06 PTZ.ARDM:VOL3

Massive Carbon Dioxide Embolism during Pneumoperitoneum for Laparoscopic Adrenalectomy Hsiao Chun Teng Huei Ming Yeh So Mong WangNai Hsin Chi<p>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&nbsp; performing&nbsp; exploratory&nbsp; laparotomy&nbsp; due&nbsp; to&nbsp; previous&nbsp; hepatic&nbsp; tumor&nbsp; excision&nbsp; related&nbsp; intra-abdominal&nbsp; adhesion,&nbsp; the&nbsp; surgeon&nbsp; tried&nbsp; to&nbsp; sow&nbsp; the&nbsp; torn&nbsp; IVC&nbsp; through&nbsp; the&nbsp; use&nbsp; of&nbsp; the&nbsp; laparoscope&nbsp; and&nbsp; to&nbsp; control&nbsp; 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.&nbsp; The&nbsp; surgeon&nbsp; spent&nbsp; about&nbsp; 60&nbsp; minutes&nbsp; on&nbsp; repairing&nbsp; the&nbsp; IVC&nbsp; tear.&nbsp; Blood&nbsp; pressure&nbsp; was&nbsp; stable during the IVC tear insult but dropped slightly after the IVC tear repaired. Low dose norepinephrine and dopamine&nbsp; continuous&nbsp; infusion&nbsp; were&nbsp; administered&nbsp; to&nbsp; stabilize&nbsp; the&nbsp; patient’s&nbsp; blood&nbsp; pressure.&nbsp; After&nbsp; the operation,&nbsp; the&nbsp; patient&nbsp; presented&nbsp; mild&nbsp; weakness&nbsp; in&nbsp; his&nbsp; left&nbsp; limbs.&nbsp; Fortunately,&nbsp; the&nbsp; symptoms&nbsp; dissipated two days after the surgery. 12 days later, the patient was discharged without any neurologic sequelae.</p> Archives of Renal Diseases and Management - Peertechz Publications 2017-07-06 Case Report https://doi.org/10.17352/2455-5495.000025 en Copyright © Hsiao Chun Teng et al.