Intraperitoneal Explosion during Female Sterilization by Laparoscopic Electrocoagulation

A report of an intraperitoneal explosion during female sterilization by laparoscopic electrocoagulation is presented. Pneumoperitoneum was created using nitrous oxide gas introduced from a Boyels anesthetic machine for 10 minutes. Immediately before withdrawing the Palmer forceps and the laparoscope a loud explosion occurred with rupture of the heart. Possible explanations of this tragedy include: 1) a charge of static electricity that moved along the laparoscope into the peritoneal cavity; 2) unrecognized bowel perforation resulting in leakage of methane gas; 3) the use of nitrous oxide which does support combustion; 4) a combustible gas may have inadvertently been administered late in the procedure; or 5) a combustible gas resulting from a combination of chemicals used to clean and sterilize the laparoscope. It is suggested that a bipolar electrocautery unit should be used. Carbon dioxide should be used in creating pneumoperitoneum and the laparoscope should be cleaned and sterilized in nonflammable chemicals and thoroughly rinsed.