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 UNUSUAL CASE
Year : 2009  |  Volume : 5  |  Issue : 2  |  Page : 35-36

Venous gas embolism: An unusual complication of laparoscopic cholecystectomy


1 Department of Anaesthetics, Barnsley Hospital NHS Foundation Trust, Gawber Road, Barnsley, S75 2PS, England, United Kingdom
2 Doncaster Royal Infirmary, Armthorpe Road, Doncaster DN2 5LT, England, United Kingdom

Correspondence Address:
Tim N Wenham
Department of Anaesthetics, Barnsley Hospital NHS Foundation Trust, Gawber Road, Barnsley, S75 2PS, England
United Kingdom
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-9941.55105

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Venous gas embolism (VGE) is a rare but potentially lethal complication of many forms of surgery, especially posterior fossa neurosurgery where the incidence is reported to be up to 80% - it can also occur in laparoscopic surgery. It usually occurs early in the procedure during insufflation of the abdomen. Rapid entry or large volumes of gas entering the venous circulation initiate a predictable chain of pathophysiological events which may continue to cardiovascular collapse. Arterial hypoxaemia, hypercapnia, decreased end-tidal CO 2 , arrhythmias, myocardial ischaemia and elevated central venous and pulmonary arterial pressures can occur. The management of VGE relies on a high index of suspicion and close liaison between anaesthetist, surgeon and theatre staff. The authors present a case of venous gas embolism (VGE) during laparoscopic cholecystectomy (LC) which presented without many of the usual clinical features and was diagnosed by auscultation of a millwheel murmur.






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