Venous Air/Gas Embolism During Surgical Hysteroscopy: An Underestimated, Potentially Lethal Complication

Hysteroscopic surgery is generally considered low risk; however, venous air/gas embolism is a potentially lethal complication with high mortality in severe cases. We summarize the pathophysiology and clinical features to support timely emergency management. A 46-year-old woman with a uterine myoma underwent hysteroscopic surgery under general anesthesia. Approximately 50 minutes after the start of the procedure, a sudden decrease in end-tidal CO₂, bradycardia, hypotension, and ST-segment elevation were observed. Transthoracic echocardiography revealed air bubbles in the right ventricle, confirming venous air/gas embolism. The procedure was discontinued, and immediate supportive management, including hemodynamic stabilization and intensive care monitoring, was initiated. The patient recovered without sequelae and was discharged on postoperative day 7. This case highlights an unusual cardiovascular presentation of venous air/gas embolism, with profound bradycardia and marked ST-segment elevation mimicking acute coronary syndrome, and emphasizes the importance of rapid diagnosis and intervention.