Medico-legal implications for carbon dioxide embolism during laparoscopic surgery: Two fatal cases

Carbon dioxide embolism is a rare complication of laparoscopic surgery resulting from direct intravascular carbon dioxide (CO2) insufflation usually due to accidental organ or vessel injury during surgery. Clinical presentation depends on the characteristics of embolized gas (speed and volume) as well as patient’s underlying medical condition. In particular, patent foramen ovale (PFO) has been found to be associated with higher risk of intraoperative entry of gas into the venous system resulting in cerebral carbon dioxide embolism (CCDE). We present two cases of fatal CCDE in patients with PFO and their medico-legal implications in terms of medical professional liability. An accurate patient’s informed consent subscription, a detailed surgical report and proper diagnostic-therapeutic management of CO2 embolism play a crucial role in clinical management and medico-legal evaluation in cases of CCDE.