Subject(s)
Gallbladder Diseases , Gallbladder Neoplasms , Neuroendocrine Tumors , Diagnosis, Differential , Gallbladder/pathology , Gallbladder Neoplasms/diagnostic imaging , Gallbladder Neoplasms/surgery , Humans , Neuroendocrine Tumors/diagnostic imaging , Neuroendocrine Tumors/pathology , Neuroendocrine Tumors/surgery , UltrasonographyABSTRACT
Transanal total mesorectal excision is a relatively new approach for treating lower rectal cancer. Carbon dioxide embolism is a critical complication of this procedure. We report the case of a 69-year-old man with lower rectal cancer who underwent transanal total mesorectal excision followed by laparoscopic low anterior resection. He had a sudden intraoperative carbon dioxide embolism during the transanal mesorectal excision. During the ventral dissection of the rectum, end-tidal carbon dioxide and blood oxygen saturation suddenly decreased. We stopped the insufflation of carbon dioxide and suspended the procedure. There was no circulatory collapse, and the vital signs gradually recovered; therefore, we resumed the surgery approximately 30 minutes later and completed it without additional complications. Upon reviewing the video, we found a small injured vein that would aspirate carbon dioxide. These findings suggested that careful hemostasis is essential to prevent carbon dioxide embolus during transanal total mesorectal excision.
Subject(s)
Embolism , Laparoscopy , Proctectomy , Rectal Neoplasms , Transanal Endoscopic Surgery , Aged , Carbon Dioxide , Embolism/complications , Embolism/surgery , Humans , Laparoscopy/adverse effects , Laparoscopy/methods , Male , Postoperative Complications/etiology , Proctectomy/adverse effects , Rectal Neoplasms/complications , Rectum/surgery , Transanal Endoscopic Surgery/adverse effects , Transanal Endoscopic Surgery/methodsABSTRACT
Analysis of oxyhemoglobin (O2-Hb) saturation levels in the left and right heart blood is useful in the assessment of exposure to cold surroundings before death. We quantified conventional subjective visual evaluation of O2-Hb saturation levels and developed useful diagnostic criteria for fatal hypothermia: O2-Hb saturation in the left heart blood (L-O2Hb) was ⩾36%, the O2-Hb saturation gap between the left and right heart blood (L-R gap) was ⩾13%, and the O2-Hb saturation ratio of the left to right heart blood (L/R ratio) was ⩾1.8. When we used L-O2Hb of ⩾36% as a basic criterion and applied a further criterion of an L-R gap of ⩾13% or an L/R ratio of ⩾1.8, these criteria registered a sensitivity level of ⩾86% and specificity level of ⩾93% for the diagnosis of fatal hypothermia. This method can be useful for determining fatal hypothermia in connection with conventional autopsy findings, as well as histological and biochemical markers.
