Intraoperative Acute Bronchospasm Mimicking Acute Chest Syndrome in a Patient with Sickle Cell Disease Undergoing Laparoscopic Cholecystectomy: A Case Report

Sickle Cell Disease (SCD) is associated with significant perioperative morbidity due to an increased risk of hypoxia, acidosis, dehydration, and stress-induced vaso-occlusive crisis. Laparoscopic procedures may further exacerbate these risks through pneumoperitoneum-induced respiratory and haemodynamic alterations. Intraoperative bronchospasm in patients with SCD is uncommon and may mimic or precipitate Acute Chest Syndrome (ACS), creating diagnostic and therapeutic challenges for the anaesthesia team. The present case is of a 59-year-old female with known SCD who presented with abdominal pain and was diagnosed with cholelithiasis, choledocholithiasis, a probable benign distal Common Bile Duct (CBD) stricture, and mild hepatosplenomegaly. Preoperative optimisation included correction of anaemia, Endoscopic Retrograde Cholangiopancreatography (ERCP), and CBD stenting. She subsequently underwent elective laparoscopic cholecystectomy under general anaesthesia. Shortly after Carbon Dioxide (CO2) insufflation and placement in the head-low position, she developed a sudden rise in End-Tidal Carbon Dioxide (EtCO2), increased peak airway pressures, and bilateral wheezing, consistent with severe intraoperative bronchospasm. Prompt management with bronchodilators and ventilatory optimisation was initiated; however, owing to persistent respiratory compromise, the procedure was converted to open cholecystectomy. The patient recovered uneventfully with postoperative supportive care, underwent successful CBD stent removal and transfusion, and was discharged in stable condition. This case is unique because severe intraoperative bronchospasm occurring during laparoscopic cholecystectomy in a patient with SCD closely simulated complications such as ACS and vaso-occlusive events. The report highlights the importance of early recognition, prompt airway management, careful intraoperative monitoring, and multidisciplinary collaboration to ensure favourable outcomes in this high-risk patient population.