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Carbon dioxide embolism is a rare but severe complication of laparoscopic hepatectomy. We reported a case of massive carbon dioxide embolism that developed into a rare paradoxical gas embolism during laparoscopic hepatectomy and resulted in reduced muscular power of the left upper extremity, severe pleural effusion and hypoalbuminemia after surgery. Fortunately, the patient fully recovered with positive prevention and postoperative treatment. This case report highlights that the surgeon and anaesthesiologist must be aware of the risks and the importance for prompt treatment when massive carbon dioxide embolism occurs.