Air embolism: Fatal air embolism due to powder insufflators used in gynecological treatments

Abstract

1. 1. Two fatal cases of air embolism of the pulmonary variety, due to the use of common powder insufflators for the relief of pruritus vulvae are reported. 2. 2. These insufflators are in common use, especially for the treatment of trichomonas infections and their main purpose is to dilate and smooth out the folds in the vagina so that the powder may be sprayed on the mucosa. Their use, therefore, depends on the distention of the vagina with air through the vaginal outlet. This is maintained by the rubber shield or shape of the instrument and by holding the insufflator tightly against the vaginal outlet. 3. 3. It is obvious, therefore, that the sudden blowing up of the vagina with air under excessive pressure is not without some danger and that fatalities may occur. The engorgement of the endometrium around the menstrual period, open veins after uterine curettage, and the soft cervix of a pregnant uterus, all might favor air embolism, during such insufflations. 4. 4. It is also reasonable to assume that very few of these catastrophies are likely to be reported and that perhaps some such deaths have been attributed to heart disease or some other condition and never verified by autopsy. 5. 5. It would seem, therefore, that such a method of treatment should either be given up, or modified, so that excessive intravaginal air pressure is not necessary to coat the vaginal walls with medicinal powders, a coating which is by no means uniform. 6. 6. In the discussion of this paper, ∗ ∗ Section of Obstetrics and Gynecology, The New York Academy of Medicine, December 26, 1944. one gynecologist suggested that if a woman is put in the knee chest position, the whole vagina will immediately balloon out with a smoothing out of its folds, allowing the vaginal mucosa and the external genitalia to be sprayed or coated with powders without excessive air pressure.