A lady presented in the emergency depament with a stab injury to the left side of the abdomen. She was hemodynamically stable and a contrast enhanced CT scan revealed a laceration in spleen. Laparoscopy was planned however the patient's p02 suddenly dropped as soon as the pneumoperitoneum was created. What is the most likely cause?
Pneumoperitoneum can lead to various complications, Gas embolism one of them which is highly dangerous and potentially lethal one. The clinical presentaion of gas embolism during laproscopy, is sudden cardiovascular collapse and hypoxia. As this patient already has the splenic aery laceration it is clear possiblity the gas that used in pneumoperitonium can gush into the blood vessel causing gas embolism. Ref: Laproscopic Surgery By Jorge Cueto-Garcia, Moises Jacobs, Michel Gagner, Page 25
Gaseous Embolism through splenic vessels
Injury to the left lobe of the diaphragm
Inferior vena cava compression
Injury to colon