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A case of carbon dioxide embolism during the transperineal approach in total pelvic exenteration for advanced anorectal cancer
Author(s) -
Matsumoto Yoshiko,
Yoshimatsu Gumpei,
Munechika Taro,
Kajitani Ryuji,
Taketomi Hirotaka,
Nagano Hideki,
Komono Akira,
Morimoto Mitsuaki,
Aisu Naoya,
Yoshida Yoichiro,
Hasegawa Suguru
Publication year - 2021
Publication title -
asian journal of endoscopic surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.372
H-Index - 18
eISSN - 1758-5910
pISSN - 1758-5902
DOI - 10.1111/ases.12832
Subject(s) - medicine , surgery , embolism , pelvic exenteration , embolus , pneumoperitoneum , rectum , percutaneous , air embolism , anesthesia , laparoscopy , complication
The transanal and transperineal endoscopic approaches are useful advanced surgical options for removing rectal and anorectal cancers. Intraoperative carbon dioxide (CO 2 ) embolisms, however, have been increasingly reported as potentially fatal complications associated with surgery employing these approaches. We report our experience with a CO 2 embolism that was detected because of a sudden drop in end‐tidal CO 2 with decreasing saturation of percutaneous arterial oxygen during total pelvic exenteration using the transperineal endoscopic approach under pneumopelvis/pneumoperitoneum. Transesophageal echocardiography confirmed that it was a CO 2 embolus. We reversed the pneumopelvis and pneumoperitoneum, which alleviated the cardiopulmonary problems, and the surgery then proceeded to achieve R0 resection. The patient was discharged without severe complications other than the CO 2 embolism.