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J Minim Access Surg. 2009 Apr;5(2):35-6. doi: 10.4103/0972-9941.55105.

Venous gas embolism: An unusual complication of laparoscopic cholecystectomy.

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Department of anaesthetics, Barnsley Hospital NHS Foundation Trust, Gawber Road, Barnsley, S75 2PS, England.


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.


CO2 embolism; laparoscopic cholecystectomy; millwheel murmur; venous gas embolism

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