Venous Air Embolism During Laparoscopic Rectal Surgery: A Case Report of Successful Resuscitation

Venous air embolism (VAE) is a rare but potentially fatal complication of laparoscopic surgery, particularly in procedures requiring Trendelenburg positioning and pneumoperitoneum. This case report describes the successful resuscitation of a 68-year-old male who developed VAE during laparoscopic resection for recurrent rectal cancer. Ninety-four minutes after the start of surgery, the patient developed acute hypotension, bradycardia, hypoxemia, and a marked decrease in end-tidal carbon dioxide (ETCO₂). Bedside transthoracic echocardiography revealed abundant gas echoes within all cardiac chambers, confirming the diagnosis of VAE. Immediate management included repositioning to Durant’s position, ventilation with 100% oxygen, intermittent external chest compressions, and vasopressor support. Despite the occurrence of transient ventricular fibrillation, sinus rhythm was restored within minutes, and the patient achieved full recovery without neurological or cardiac sequelae. This case highlights the critical importance of early recognition of VAE through integrated hemodynamic monitoring and echocardiography, and demonstrates the effectiveness of a multimodal resuscitation strategy in achieving favorable clinical outcomes. It also underscores the need for heightened vigilance and well-prepared emergency response protocols during high-risk laparoscopic procedures.