McIntosh Pamela G, Andrew Chris G
Department of Surgery, University of Manitoba, Winnipeg, MB, Canada.
J Surg Case Rep. 2021 Oct 27;2021(10):rjab448. doi: 10.1093/jscr/rjab448. eCollection 2021 Oct.
Laparoscopy is being applied more frequently and in broader applications. Complications of this technique are infrequent, and rare among them are gas emboli due to insufflation. This paper describes a 65-year-old obese female presenting for elective laparoscopic cholecystectomy who suffered a cerebral vascular accident after Veress needle insertion into undiagnosed severe fatty liver led to a massive gas embolus. Our patient experienced immediate cardiac compromise and acute monoparesis. Intra-operative transesophageal echocardiogram revealed copious air in the right atria and ventricle. A needle track within the liver was visible on a post-operative computerized tomography scan. The patient made a full recovery, but this acts as a reminder to be vigilant for potential complications of laparoscopy and highlights challenges of laparoscopic entry in the severely obese.
腹腔镜检查的应用越来越频繁，应用范围也越来越广泛。该技术的并发症并不常见，其中因气腹导致的气体栓塞则更为罕见。本文描述了一名65岁的肥胖女性，因择期腹腔镜胆囊切除术就诊，在未确诊的严重脂肪肝患者中，Veress针插入后导致大量气体栓塞，进而引发脑血管意外。我们的患者立即出现心脏功能不全和急性单瘫。术中经食管超声心动图显示右心房和右心室内有大量气体。术后计算机断层扫描显示肝脏内有针道。患者完全康复，但这提醒我们要警惕腹腔镜检查的潜在并发症，并突出了严重肥胖患者腹腔镜穿刺入路的挑战。
