Fatal carbon dioxide embolism and severe haemorrhage during laparoscopic salpingectomy

We report a case of fatal carbon dioxide embolism and severehaemorrhage during laparoscopic salpingectomy. A sudden decreasein end-tidal carbon dioxide concentration occurred after 1 hof operating time which, together with the clinical signs, suggestedcarbon dioxide embolism. Haemorrhage after pelvic venous injurywas first noted after deflation of the pneumoperitoneum andresulted in potentiation of the adverse haemodynamic effectsof massive gas embolism. Minimally invasive surgery involvesmore extensive tissue trauma and an increased duration of pneumoperitoneumcompared with diagnostic laparoscopy and may increase the riskof serious complications.