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Intraoperative Myocardial Infarction During Elective Laparoscopic Cholecystectomy: A Case Report
Amr Barghout1, Bethany Plummer1
1Anaesthesia, Medway NHS Foundation Trust, Kent, GBR.
Insights
Pneumoperitoneum during laparoscopic cholecystectomy can cause cardiac events in at-risk patients. Thorough preoperative evaluation and prompt intraoperative management are crucial for patient safety during minimally invasive surgery.
Area of Science:
- Cardiology
- Gastroenterology
- Minimally Invasive Surgery
Background:
- Laparoscopic cholecystectomy is the standard treatment for symptomatic gallstones.
- Pneumoperitoneum, created using carbon dioxide (CO2) insufflation, is essential for laparoscopic surgery.
- Increased intra-abdominal pressure during pneumoperitoneum can affect cardiovascular function.
Observation:
- A case of intraoperative myocardial infarction (MI) during laparoscopic cholecystectomy is presented.
- The patient experienced hemodynamic instability, including bradycardia and hypotension.
- Diagnosis was confirmed by electrocardiographic findings and cardiac biomarkers.
Findings:
- Pneumoperitoneum-induced hemodynamic changes can precipitate acute cardiac events, especially in patients with cardiovascular risk factors.
- Undiagnosed coronary artery disease was identified as a contributing factor in this case.
- Immediate interventions included hemodynamic stabilization and cessation of pneumoperitoneum.
Implications:
- Thorough preoperative cardiovascular assessment is vital for patients undergoing even minimally invasive procedures.
- Recognizing the hemodynamic impact of pneumoperitoneum is crucial for preventing intraoperative complications.
- Effective management requires timely intervention and access to cardiology expertise.
Abstract:
Laparoscopic cholecystectomy has become the gold standard for treating symptomatic cholelithiasis due to its minimally invasive nature and faster recovery times compared to traditional open surgery, but it is not without risks. A key component of this procedure is the creation of pneumoperitoneum. This is achieved by insufflating the abdomen with carbon dioxide (CO2). This process causes an increased intra-abdominal pressure (IAP), reduced venous return, and disrupted myocardial oxygen supply and demand. These changes may predispose vulnerable patients to acute cardiac events, particularly those with underlying cardiovascular risk factors. We present a case study of an intraoperative myocardial infarction (MI) that occurred during an elective laparoscopic cholecystectomy. During the procedure, the patient exhibited acute haemodynamic instability (bradycardia and hypotension). Electrocardiographic findings and cardiac biomarkers later confirmed the diagnosis. Immediate intraoperative interventions, including stabilisation of haemodynamics and removal of pneumoperitoneum. Postoperative recovery was monitored in the intensive care unit (ICU), with subsequent investigations identifying pre-existing but previously undiagnosed coronary artery disease as a contributing factor. This case highlights the importance of thorough preoperative cardiovascular evaluation, particularly in patients with risk factors for coronary artery disease, even for procedures considered minimally invasive. It also stresses the potential role of pneumoperitoneum in precipitating acute cardiac events due to its significant haemodynamic impact. Timely intraoperative management, combined with prompt access to cardiology expertise, evaluation, and invasive interventions, is essential for optimising patient outcomes in such cases.
