Carbon dioxide embolism in a 3-week-old neonate during laparoscopic pyloromyotomy: a case report

Abstract Laparoscopic pyloromyotomy has gained popularity in the treatment of hypertrophic pyloric stenosis. This is the first case report of carbon dioxide embolism during laparoscopic pyloromyotomy. We describe a case of carbon dioxide embolism in a 3-week-old neonate during laparoscopic pyloromyo...

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Bibliographic Details
Published in:Journal of pediatric surgery 2009-04, Vol.44 (4), p.842-845
Main Authors: Kudsi, Omar Yusef, Jones, Sarah A, Brenn, B. Randall
Format: Article
Language:English
Subjects:
Carbon dioxide
Carbon Dioxide - adverse effects
Carbon Dioxide - pharmacology
Complication
Embolism, Air - chemically induced
Embolism, Air - physiopathology
End-tidal CO 2
Female
Follow-Up Studies
Gas embolism
Humans
Infant, Newborn
Injections, Intravenous
Laparoscopic pyloromyotomy
Laparoscopy - adverse effects
Laparoscopy - methods
Laparotomy - methods
Pediatrics
Pneumoperitoneum, Artificial - adverse effects
Pyloric Stenosis, Hypertrophic - diagnosis
Pyloric Stenosis, Hypertrophic - surgery
Reoperation
Risk Assessment
Surgery
Treatment Outcome
Twins
Umbilical Veins
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Summary:Abstract Laparoscopic pyloromyotomy has gained popularity in the treatment of hypertrophic pyloric stenosis. This is the first case report of carbon dioxide embolism during laparoscopic pyloromyotomy. We describe a case of carbon dioxide embolism in a 3-week-old neonate during laparoscopic pyloromyotomy by injection of carbon dioxide into a patent umbilical vein. The diagnosis of carbon dioxide embolism was made on the basis of the abrupt decrease in end-tidal CO2 , sudden decreased Sp o2 , hypotension, and cyanosis. Portable x-ray with the clinical presentation was sufficient for a diagnosis of carbon dioxide embolism. Treatment included termination of CO2 insufflation, placing the patient in Durant's position, and adequate resuscitation as necessary. Despite the fact that the insufflation pressure was in the recommended range, a carbon dioxide embolism was thought to be caused by injection of carbon dioxide into a patent umbilical vein. Although laparoscopic pyloromyotomy has demonstrated to be a safe and effective procedure, this is a serious and rare complication causing prolonged length of stay and skewed hospital charges.
ISSN:0022-3468
1531-5037
DOI:10.1016/j.jpedsurg.2008.11.045