ABSTRACT
Carbon dioxide (CO2) embolism is a rare but potentially life-threatening complication of laparoscopic procedures. Although endoscopic thyroidectomy using CO2 gas insufflation appears to be superior to conventional open thyroidectomy in terms of cosmetic results, it may cause venous or fatal paradoxical CO2 embolism. We report a case of paradoxical CO2 embolism during CO2 gas insufflation in an endoscopic thyroidectomy that was confirmed by transesophageal echocardiography (TEE). Paradoxical embolization via transpulmonary right-to-left shunting of venous CO2 gas emboli was revealed by TEE examination. The patient recovered without complications. In conclusion, although endoscopic thyroidectomy is a promising approach that is gaining popularity and offers excellent cosmetic results compared with conventional open thyroidectomy, this case report emphasizes the importance of anticipating and being vigilant for potential CO2 embolism.
Subject(s)
Carbon Dioxide , Embolism, Air/diagnostic imaging , Embolism, Paradoxical/diagnostic imaging , Endoscopy , Intraoperative Complications/diagnostic imaging , Thyroidectomy , Diagnosis, Differential , Echocardiography, Transesophageal , Embolism, Air/etiology , Embolism, Paradoxical/etiology , Female , Hemodynamics/physiology , Humans , Insufflation , Intraoperative Complications/etiology , Middle Aged , Pulmonary Embolism/diagnosis , Pulmonary Embolism/diagnostic imagingABSTRACT
We report here on a fatal case of abdominal gas gangrene. Two days after gastrectomy, a 56-year-old man presented with intractable abdominal pain and fever of a sudden onset, which quickly progressed over several hours to septic shock. Despite of the unexplained gas collections in the abdominal muscle, fascia, and subcutaneous layers on computed tomography scan, its clinical significance was overlooked. Emergency laparotomy was initially scheduled because of concern that there may have been a perforated viscus. At the time of monitoring for the anesthesia, we noticed marbled skin discoloration and the subcutaneous emphysema had spread on his flank. Shortly after the initial suspicion of gas gangrene, cardiac arrest developed during the arterial line cannulation. Despite prompt resuscitation measures, including the administration of catecholamines and the application of extracoporeal membrane oxygenation, he eventually died. Anesthesiologists need to understand this fulminant disease because extensive debridement under general anesthesia is essential for the treatment of abdominal gas gangrene.
