Why the study?
Intraoperative carbon dioxide embolisms have been increasingly reported as potentially fatal complications associated with surgery employing transanal and transperineal endoscopic approaches.
Prompt detection and reversal of pneumopelvis/pneumoperitoneum can effectively manage potentially fatal CO2 embolism during transperineal endoscopic surgery.
CO2 embolism risk persists in transanal endoscopic rectal surgery; case report leaves open optimal monitoring and prevention strategies.
The transanal and transperineal endoscopic approaches are useful advanced surgical options for removing rectal and anorectal cancers. Intraoperative carbon dioxide (CO2) embolisms, however, have been increasingly reported as potentially fatal complications associated with surgery employing these approaches. We report our experience with a CO2 embolism that was detected because of a sudden drop in end‐tidal CO2 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 CO2 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 CO2 embolism.
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Matsumoto et al. (2020) studied this question.
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