1012 - The Rare Gas Bubble - Carbon Dioxide Emboli leads to Severe Anoxic Brain Injury

Thursday, February 19, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

CU

Chidera Uzowihe, MD, MPH

Resident physician
Atrium Health Carolinas Rehabilitation
Charlotte, North Carolina, United States

Co-Author(s)

SD

Sima Desai, MD

Brain Injury Medicine Fellowship Program Director
Atrium Health Carolinas Rehabilitation
Charlotte, North Carolina, United States

Submitter(s)

CU

Chidera Uzowihe, MD

Atrium Health Carolinas Rehabilitation
Charlotte, North Carolina, United States

Case Diagnosis: Anoxic brain injury (BI) after carbon dioxide embolus during laparoscopic surgery

Case Description: 48 year old female with a history of distal gastrectomy presented for a planned laparoscopic gastrostomy tube placement for chronic gastroparesis. During abdominal insufflation, she developed a carbon dioxide embolus, complete heart block, and subsequent cardiac arrest for 10 minutes. Her hospital course was complicated by myoclonus and persistence of an unresponsive wakefulness state. On admission to rehab, she presented with no vocalization, visual fixation, or command following, with a score of 5 on the revised JFK Coma Recovery Scale (CRS-R). During rehab stay, she had persistent infections and rapid weight loss of 12 pounds over 14 days due to poor enteral feed absorption and pneumatosis intestinalis, which ultimately resolved after total parental nutrition was started. By discharge after 6 weeks, she was back to her baseline weight, and had reproducible command following, functional object use, vocalization, and maximal assistance with improved scores on the CRS-R.

Discussions: A carbon dioxide embolus is a rare occurrence, with an incidence of 0.1-0.6% in laparoscopic procedures with a mortality rate of approximately 28%. The patient’s severe presentation of anoxic BI was unique due to its multifactorial etiology of cardiac arrest, complete heart block, and the rare carbon dioxide embolus.

Conclusions: This case emphasizes the severe sequelae of carbon dioxide emboli and the multifactorial nature of anoxic brain injury, as well as the importance of serial documentation of JFK CRS-R in brain injury rehabilitation, to trend functional progress and emergence from a minimally conscious state.