Abstract
A 79-year-old-man who was diagnosed as having hepatocellular carcinoma underwent laparoscopic partial liver resection. However, dense adhesions in the upper abdominal cavity and bleeding from the liver cutting surface made the surgery difficult. After induction of pneumoperitoneum, the EtCO2 level in this patient persisted at around 50 mm Hg. At around 5 hours after the start of CO2 insufflation to produce pneumoperitoneum, the blood pressure of the patient suddenly dropped to 50 mm Hg and the EtCO2 level decreased to 28 mm Hg. Results of arterial blood gas analysis performed at this time revealed a pH of 7.253 and PaCO2 of 56.8 mm Hg. Based on the discrepancy between the PaCO2 and EtCO2, the patient was diagnosed as having pneumoperitoneum-induced gas embolism. Therefore, the surgical approach was changed to the conventional open approach. Following conversion to the open approach, hemostasis was achieved at the liver cutting surface, the blood pressure rapidly recovered, and the surgery was completed without any further events. The postoperative course was also uneventful and the patient was discharged on postoperative day 12. The need for careful monitoring for preventing severe gas embolism in patients undergoing laparoscopic resection cannot be overemphasized, especially in the event of unexpectedly prolonged surgery or excessive bleeding.
