Gynaecological pathology: Uterus: Air embolism following laparoscopy

An autopsy specimen from a 24 year old woman 8 weeks into her first pregnancy, taken to hospital with abdominal pain and bleeding PV. A laparoscopy was undertaken. For this procedure a needle was introduced through a suprapubic puncture. The laparoscope was introduced through a separate incision just below the first needle. The patient collapsed and died shortly after this injection. At post mortem the needle was found to have passed through the uterus and was lodged in the posterior abdominal wall. Gas bubbles were found in the inferior vena cava, ovarian veins, the right atrium, coronary veins, coronary arteries and cerebral arteries. The gas bubbles in the arteries are explained by the fact that there was a small atrio-septal defect.