A lady presented in the emergency depament with a stab injury to the left side of the abdomen. She was hemodyamically stable and a contrast enhanced CT scan revealed a laceration in spleen and a contrast enhanced CT scan revealed a laceration in spleen. Laparoscopy was planned, however the patients PO2 suddenly dropped as soon as the pneumonperitoneum was created. What is the most likely cause?
Sudden drop in pO2 immediately during induction of pneumoperitoneum at the time of insuflations of gas from unintended insufflations of gas directly into an open vein. Gas embolism may have resulted from inadveent inseion of the trocar or veress needle into a vessel or abdominal organ. Gas Embolism Most commonly seen during induction of pneumonperitoneum at the time of insufflations of gas directly into an open vein. The more soluble a gas in the blood, the lower chances are for gas embolism CO2 is preferred for pnemoperitoneum as it is highly soluble in blood and is rapidly eliminated. CO2 Embolism: An initial rise in ET-CO2 due to pulmonary excretion of absorbed CO2 is followed by a sudden decrease due to fall in cardiac output. Ref: Laparoscopic Surgery By Garcia & Jacobs/25
Gaseous embolism through splenic vessels
Injury to the left lobe the diaphragm
Inferior vena cava compression
Injury to colon
General surgery