Intraoperative Myocardial Infarction During Elective Laparoscopic Cholecystectomy: A Case Report

Laparoscopic cholecystectomy has become the gold standard for treating symptomatic cholelithiasis due to its minimally invasive nature and faster recovery times compared to traditional open surgery, but it is not without risks. A key component of this procedure is the creation of pneumoperitoneum. This is achieved by insufflating the abdomen with carbon dioxide (CO2). This process causes an increased intra-abdominal pressure (IAP), reduced venous return, and disrupted myocardial oxygen supply and demand. These changes may predispose vulnerable patients to acute cardiac events, particularly those with underlying cardiovascular risk factors. We present a case study of an intraoperative myocardial infarction (MI) that occurred during an elective laparoscopic cholecystectomy. During the procedure, the patient exhibited acute haemodynamic instability (bradycardia and hypotension). Electrocardiographic findings and cardiac biomarkers later confirmed the diagnosis. Immediate intraoperative interventions, including stabilisation of haemodynamics and removal of pneumoperitoneum. Postoperative recovery was monitored in the intensive care unit (ICU), with subsequent investigations identifying pre-existing but previously undiagnosed coronary artery disease as a contributing factor. This case highlights the importance of thorough preoperative cardiovascular evaluation, particularly in patients with risk factors for coronary artery disease, even for procedures considered minimally invasive. It also stresses the potential role of pneumoperitoneum in precipitating acute cardiac events due to its significant haemodynamic impact. Timely intraoperative management, combined with prompt access to cardiology expertise, evaluation, and invasive interventions, is essential for optimising patient outcomes in such cases.