期刊名称：General Internal Medicine and Clinical Innovations
电子版ISSN：2397-5237
出版年度：2017
卷号：2
期号：1
页码：1-3
DOI：10.15761-GIMCI.1000134
语种：English
出版社：Open Access Text
摘要：A 65-year-old man, with suspected right adrenal metastasis from hepatic carcinoma, was scheduled to undergo a laparoscopic right adrenalectomy. About 75 minutes into the operation, when attempting to remove the adrenal gland that was tightly adhesive to the IVC, the surgeon accidently nicked the large inferior vena cava which resulted in a (IVC) tear of about 2×2 cm. Considering the difficulty of performing exploratory laparotomy due to previous hepatic tumor excision related intra-abdominal adhesion, the surgeon tried to sow the torn IVC through the use of the laparoscope and to control the bleeding via carbon dioxide (CO2) insufflation pressure. This resulted in a massive amount of gas entering the vessel via the IVC broken hole. When we performed a transesophageal echocardiography(TEE), it was revealed that the right atrium and right ventricle were totally white out because they were full of air (Figure 1). About 20 minutes after the IVC tear, the TEE image also revealed that the left heart also contained scattered air embolisms (Figure 2). The surgeon spent about 60 minutes on repairing the IVC tear. Blood pressure was stable during the IVC tear insult but dropped slightly after the IVC tear repaired. Low dose norepinephrine and dopamine continuous infusion were administered to stabilize the patient’s blood pressure. After the operation, the patient presented mild weakness in his left limbs. Fortunately, the symptoms dissipated two days after the surgery. 12 days later, the patient was discharged without any neurologic sequelae.
