Fatal pulmonary bile embolism following acute acalculous cholecystitis
A. D. Proia, B. F. Fetter, B. H. Woodard, D. L. Stickel and W. C. Meyers
A 52-year-old man died during reoperation for bleeding after the
development of acute postoperative acalculous cholecystitis. While the
liver was being manipulated during surgery, the pulmonary artery diastolic
pressure increased suddenly, cardiac output and blood pressure decreased,
and soon afterward the patient had a cardiac arrest from which he could not
be resuscitated. During resuscitative efforts, the maximum partial arterial
oxygen pressure achieved was only 55 mm Hg despite 100% inspired oxygen. At
autopsy, bile aggregates were found within necrotic liver parenchyma,
portal and central vein branches, and numerous pulmonary arterioles and
capillaries. The pulmonary arterial bile most likely resulted from
embolization of inspissated hepatic bile aggregates during surgical
manipulation.
