Yonsei Med J.  2008 Aug;49(4):676-679. 10.3349/ymj.2008.49.4.676.

Pulmonary Edema after Catastrophic Carbon Dioxide Embolism during Laparoscopic Ovarian Cystectomy

• Lee Y
• Kim ES
• Lee HJ

• KMID: 1793208
• DOI: http://doi.org/10.3349/ymj.2008.49.4.676

Abstract

Laparoscopy is a surgical procedure used both for diagnosis and for various treatments. A rare but sometimes fatal complication of laparoscopy is pulmonary embolism with CO2 resulting in pulmonary edema. During laparoscopic gynecological surgery in a 29-year-old woman who had previously undergone lower abdominal surgery, the end-tidal CO2 suddenly increased from 40mmHg to 85mmHg and then decreased to 13mmHg with hemodynamic deterioration. These events are characteristic of a CO2 embolism. When this occurred, CO2 insufflation was immediately stopped and the patient was resuscitated. The patient's condition gradually improved with aggressive treatment, but the clinical course was complicated by bilateral pulmonary edema. This case of pulmonary edema was soon resolved with supportive management. The formation of a CO2 embolism during laparoscopy must be suspected whenever there is a sudden change in the end-tidal CO2. In addition, the possibility of pulmonary edema should be considered when a CO2 embolism occurs.

Keyword

Carbon dioxide; laparoscopy; pulmonary edema; pulmonary embolism

MeSH Terms

Adult
Carbon Dioxide/*metabolism
*Cystectomy
Female
Humans
*Laparoscopy
Ovarian Cysts/*surgery
Pulmonary Edema/*complications/metabolism/radiography
Pulmonary Embolism/*complications/metabolism/radiography

Figure

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  Fig. 1 Chest PA taken before the surgery shows no evidence of a definite abnormality.

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  Fig. 2 Chest AP taken 40 minutes after the CO2 embolism shows newly developing bilateral extensive consolidations in the lungs, indicating pulmonary edema.

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  Fig. 3 Chest AP taken the morning after surgery shows clear lungs without an enlarged heart.

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