Fatal carbon dioxide embolism and severe haemorrhage during laparoscopic salpingectomy

We report a case of fatal carbon dioxide embolism and severe haemorrhage during laparoscopic salpingectomy. A sudden decrease in end-tidal carbon dioxide concentration occurred after 1 h of operating time which, together with the clinical signs, suggested carbon dioxide embolism. Haemorrhage after pelvic venous injury was first noted after deflation of the pneumoperitoneum and resulted in potentiation of the adverse haemodynamic effects of massive gas embolism. Minimally invasive surgery involves more extensive tissue trauma and an increased duration of pneumoperitoneum compared with diagnostic laparoscopy and may increase the risk of serious complications.