Case 53 - A 25-Year-Old Woman with Sudden Cardiovascular Collapse after Creation of Pneumoperitoneum

Summary

A 25-year-old female, gravida 0, with chronic pelvic pain presents for a scheduled diagnostic laparoscopy. Her medical and surgical history is otherwise unremarkable. She relies on depot medroxyprogesterone acetate for contraception and has no known drug allergies. Anesthetic induction and intubation proceeded without complication. Laparoscopic entry is attempted using the Veress needle. Following two unsuccessful attempts at sub-umbilical insufflation, insertion of the Veress is attempted at Palmer’s point, 3 cm below the costal margin in the left midclavicular line. Opening pressure at Palmer’s point is 14 mmHg. The needle is retracted slightly, the pressure decreases appropriately to 5 mmHg, and abdominal insufflation proceeds. Upon placement of the initial trocar and visualization of the abdominal cavity with the laparoscope, a 2.5 cm laceration is noted along the inferior border of the left hepatic lobe. Bleeding is minimal and pressure is applied. Approximately 2 minutes later, the anesthesiologist alerts the surgeon of acute-onset tachycardia, hypotension, and hypoxia.