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A Rare Intraoperative Complication: Venous Air Embolism During Laparoscopic Cholecystectomy – A Case Report

Year 2025, Volume: 1 Issue: 2, 96 - 99, 01.09.2025

Abstract

Background: Venous air embolism (VAE) is a rare but potentially fatal complication that may occur in laparoscopic procedures, particularly during the creation of pneumoperitoneum. Rapid diagnosis and intervention are essential for preventing severe outcomes.
Case Presentation: We report the case of a 24-year-old female patient who underwent elective laparoscopic cholecystectomy. Shortly after initiation of pneumoperitoneum, bradycardia, hypotension, hypoxemia, and a sudden decrease in end-tidal CO₂ developed. Immediate cessation of insufflation, placement of the patient in the Durant’s position, and central venous catheterization for air aspiration were performed. Approximately 20 cc of air was aspirated, leading to rapid hemodynamic stabilization.
Conclusion: Prompt identification and management, including discontinuation of insufflation, Durant’s positioning, and central venous aspiration, provided rapid hemodynamic stabilization. This case emphasizes the importance of intraoperative alertness and rapid interventions in the management of VAE.

References

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  • 8. Shin HY, Kim DW, Kim JD, et al. Paradoxical carbon dioxide embolism during laparoscopic cholecystectomy as a cause of cardiac arrest and neurologic sequelae: a case report. Korean J Anesthesiol. 2014 Dec;67(6):425-8. doi: 10.4097/kjae.2014.67.6.425. Epub 2014 Dec 29.
  • 9. Lantz PE, Smith JD. J Fatal carbon dioxide embolism complicating attempted laparoscopic cholecystectomy-case report and literature review. Forensic Sci. 1994 Nov;39(6):1468-80.
  • 10. Uchida S, Yamamoto M, Masaoka Y, Mikouchi H, Nishizaki Y. A case of acute pulmonary embolism and acute myocardial infarction with suspected paradoxical embolism after laparoscopic surgery. Heart Vessels. 1999;14:197–200. doi: 10.1007/BF02482307.
  • 11. Shimizu K, Usuda M, Kakizaki Y, et al. Cerebral infarction by paradoxical gas embolism detected after laparoscopic partial hepatectomy with an insufflation management system: a case report. surg case rep 2023;9:34. https://doi.org/10.1186/s40792-023-01611-0

Year 2025, Volume: 1 Issue: 2, 96 - 99, 01.09.2025

Abstract

References

  • 1. Buia A, Stockhausen F, Hanisch E. Laparoscopic surgery: A qualified systematic review. World J Methodol. 2015 Dec 26;5(4):238-54. doi: 10.5662/wjm.v5.i4.238.
  • 2. Park Kwon JY, Kim KJ. Carbon dioxide embolism during laparoscopic surgery. Yonsei Med J. 2012 May;53(3):459-66. doi: 10.3349/ymj.2012.53.3.459.
  • 3. Schlimp CJ, Loimer T, Rieger M, Lederer W. Venous air embolism during surgery: detection and management. Minerva Anestesiol. 2020;86(2):202–211
  • 4. Mirski MA, Lele AV, Fitzsimmons L, Toung TJK. Diagnosis and treatment of vascular air embolism. Anesthesiology. 2007;106(1):164–77. doi:10.1097/00000542-200701000-00026
  • 5. Muth CM, Shank ES. Gas embolism. N Engl J Med. 2000;342(7):476–82. doi:10.1056/NEJM200002173420706
  • 6. McCarthy CJ, Behravesh S, Naidu SG, Oklu R. Air embolism: diagnosis, clinical management and outcomes. Diagnostics (Basel). 2017;7(1):5. doi:10.3390/diagnostics7010005
  • 7. Davolio MC, Pizzirani M, Vecchio S, et al. Medico-legal implications for carbon dioxide embolism during laparoscopic surgery: Two fatal cases. Forensic Science International: Reports.2023 p. 100304 . doi: 10.1016/j.fsir.2022.100304
  • 8. Shin HY, Kim DW, Kim JD, et al. Paradoxical carbon dioxide embolism during laparoscopic cholecystectomy as a cause of cardiac arrest and neurologic sequelae: a case report. Korean J Anesthesiol. 2014 Dec;67(6):425-8. doi: 10.4097/kjae.2014.67.6.425. Epub 2014 Dec 29.
  • 9. Lantz PE, Smith JD. J Fatal carbon dioxide embolism complicating attempted laparoscopic cholecystectomy-case report and literature review. Forensic Sci. 1994 Nov;39(6):1468-80.
  • 10. Uchida S, Yamamoto M, Masaoka Y, Mikouchi H, Nishizaki Y. A case of acute pulmonary embolism and acute myocardial infarction with suspected paradoxical embolism after laparoscopic surgery. Heart Vessels. 1999;14:197–200. doi: 10.1007/BF02482307.
  • 11. Shimizu K, Usuda M, Kakizaki Y, et al. Cerebral infarction by paradoxical gas embolism detected after laparoscopic partial hepatectomy with an insufflation management system: a case report. surg case rep 2023;9:34. https://doi.org/10.1186/s40792-023-01611-0
There are 11 citations in total.

Details

Primary Language English
Subjects Anaesthesiology
Journal Section Case Report/Case Series
Authors

Elif Durmuş This is me 0000-0003-0492-5476

Sezer Kuzu This is me 0009-0006-2219-4354

Büşra Ari This is me 0009-0009-5165-2504

Mustafa Özgür Cırık 0000-0002-9449-9302

Münire Babayiğit 0000-0002-5090-3262

Hilal Sazak 0000-0003-1124-7861

Publication Date September 1, 2025
Submission Date July 2, 2025
Acceptance Date July 31, 2025
Published in Issue Year 2025 Volume: 1 Issue: 2

Cite

Vancouver Durmuş E, Kuzu S, Ari B, Cırık MÖ, Babayiğit M, Sazak H. A Rare Intraoperative Complication: Venous Air Embolism During Laparoscopic Cholecystectomy – A Case Report. Sanatorium Med J. 2025;1(2):96-9.

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