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Frydrych M, Łukaszewski M, Nelke K, Janeczek M, Małyszek A, Nienartowicz J, Gogolewski G, Dobrzyński M. Analysis of Tomographic Images of a Catastrophic Gas Embolism during Endoscopic Retrograde Cholangiopancreatography. Diagnostics (Basel) 2024; 14:1425. [PMID: 39001315 PMCID: PMC11241030 DOI: 10.3390/diagnostics14131425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 06/28/2024] [Accepted: 07/01/2024] [Indexed: 07/16/2024] Open
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) is a commonly performed minimally invasive procedure. Air embolism in a patient undergoing ERCP is relatively rare, accounting for approximately 2-3% of procedures performed, and a catastrophic air embolism is even rarer. Symptoms of air embolism can come from the cardiopulmonary and nervous system. It is important to remember this in the differential diagnosis of complications of ERCP, as early detection is crucial. In the case presented here, the diagnostic CT scan performed immediately after the incident brings awareness of how massive an air embolism can be. The CT results showed gas bubbles entering both the superior and inferior vena cava. The presence of air has been captured in the bile ducts, duodenum wall, heart, femoral veins and intracranially. Risk factors for this complication include previous biliary surgeries, the presence of prostheses and stents, cholangitis, liver tumors and anatomical anomalies such as hepatobiliary fistulas, as well as intrahepatic and extrahepatic anatomical leaks. As gas embolism is associated with serious health consequences, knowledge of the problem and adequate preparation may reduce the occurrence of the problem. Attention should be paid to basic and easily obtainable precautions when performing the procedure, such as the patient's hemodynamic status, adequate hydration and positioning during the procedure.
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Affiliation(s)
- Marta Frydrych
- Sokolowski Specialist Hospital in Walbrzych, Sokolowski, 58-309 Walbrzych, Poland
| | - Marceli Łukaszewski
- Sokolowski Specialist Hospital in Walbrzych, Sokolowski, 58-309 Walbrzych, Poland
| | - Kamil Nelke
- Private Practice of Maxillo-Facial Surgery and Maxillo-Facial Surgery Ward, EMC Hospital, Pilczycka 144, 54-144 Wrocław, Poland
- Health Department, Academy of Applied Sciences Angelus Silesius in Wałbrzych, Zamkowa 4, 58-300 Walbrzych, Poland
| | - Maciej Janeczek
- Department of Biostructure and Animal Physiology, Wrocław University of Environmental and Life Sciences, Kożuchowska 1, 51-631 Wrocław, Poland
| | - Agata Małyszek
- Department of Biostructure and Animal Physiology, Wrocław University of Environmental and Life Sciences, Kożuchowska 1, 51-631 Wrocław, Poland
| | - Jan Nienartowicz
- Private Practice of Maxillo-Facial Surgery, Romualda Mielczarskiego 1, 51-663 Wrocław, Poland
| | - Grzegorz Gogolewski
- Department of Emergency Medicine, Wrocław Medical University, Borowska 213, 50-556 Wrocław, Poland
| | - Maciej Dobrzyński
- Department of Pediatric Dentistry and Preclinical Dentistry, Wrocław Medical University, Krakowska 26, 50-425 Wrocław, Poland
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Medhioub M, Trabelsi B, Khsiba A, Saied M, Mahmoudi M, Mohamed AB, Yacoubi M, Hamzaoui L, Ali MB. Air embolism complicating endoscopic retrograde cholangiopancreatography. Future Sci OA 2024; 10:FSO941. [PMID: 38841180 PMCID: PMC11152584 DOI: 10.2144/fsoa-2023-0174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/13/2023] [Indexed: 06/07/2024] Open
Abstract
Aim: Venous air embolism is a rare but potentially life threatening complication of endoscopic retrograde cholangiopancreatography. Diagnosis is difficult because of the lack of specific signs or symptoms. Case: A 62-year-old man underwent endoscopic retrograde cholangiopancreatography for choledocholithiasis. A cardiovascular collapse occurred during the procedure. The echocardiography showed air within the right ventricle. Aspiration of air from the right ventricle was done and saved the patient's life. Conclusion: We highlight through this case that increased awareness is essential for prompt recognition of the air embolism to allow life-saving therapy.
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Affiliation(s)
- Mouna Medhioub
- Gastroenterology Department, Mohamed Taher Maamouri Hospital, Mrezgua, 8000, Nabeul, Tunisia
- Université de Tunis El Manar – Faculté de médecine de Tunis, 1006, Tunisie
| | - Becem Trabelsi
- Anesthesia Department, Mohamed Taher Maamouri Hospital, Mrezgua, 8000, Nabeul, Tunisia
- Université de Tunis El Manar – Faculté de médecine de Tunis, 1006, Tunisie
| | - Amal Khsiba
- Gastroenterology Department, Mohamed Taher Maamouri Hospital, Mrezgua, 8000, Nabeul, Tunisia
- Université de Tunis El Manar – Faculté de médecine de Tunis, 1006, Tunisie
| | - Mohamed Saied
- Anesthesia Department, Mohamed Taher Maamouri Hospital, Mrezgua, 8000, Nabeul, Tunisia
| | - Moufida Mahmoudi
- Gastroenterology Department, Mohamed Taher Maamouri Hospital, Mrezgua, 8000, Nabeul, Tunisia
- Université de Tunis El Manar – Faculté de médecine de Tunis, 1006, Tunisie
| | - Asma Ben Mohamed
- Gastroenterology Department, Mohamed Taher Maamouri Hospital, Mrezgua, 8000, Nabeul, Tunisia
- Université de Tunis El Manar – Faculté de médecine de Tunis, 1006, Tunisie
| | - Manel Yacoubi
- Gastroenterology Department, Mohamed Taher Maamouri Hospital, Mrezgua, 8000, Nabeul, Tunisia
- Université de Tunis El Manar – Faculté de médecine de Tunis, 1006, Tunisie
| | - Lamine Hamzaoui
- Gastroenterology Department, Mohamed Taher Maamouri Hospital, Mrezgua, 8000, Nabeul, Tunisia
- Université de Tunis El Manar – Faculté de médecine de Tunis, 1006, Tunisie
| | - Mechaal Ben Ali
- Anesthesia Department, Mohamed Taher Maamouri Hospital, Mrezgua, 8000, Nabeul, Tunisia
- Université de Tunis El Manar – Faculté de médecine de Tunis, 1006, Tunisie
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Ahmad HS, Cohen SA, Khoury T, Tome R, Zeibak H, Abboud W, Mari A. Gas Embolism After a Patient's Ninth ERCP Procedure. ACG Case Rep J 2023; 10:e01124. [PMID: 37575487 PMCID: PMC10419710 DOI: 10.14309/crj.0000000000001124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/16/2023] [Accepted: 07/08/2023] [Indexed: 08/15/2023] Open
Abstract
Gas embolism is a rare and potentially fatal complication of endoscopic retrograde cholangiopancreatography (ERCP). We present a 66-year-old man who developed gas embolism after undergoing therapeutic ERCP for cholangitis. Some risk factors of gas embolism in this patient included stones in the common bile duct with cholangitis and a history of multiple ERCP procedures. Early diagnosis and rapid treatment of this potentially fatal complication resulted in our patient's full recovery.
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Affiliation(s)
- Helal Said Ahmad
- Gastroenterology and Endoscopy Unit, Nazareth Hospital EMMS, Nazareth, Israel
| | - Sari Anne Cohen
- Medical School for International Health, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Tawfik Khoury
- Gastroenterology and Endoscopy Unit, Nazareth Hospital EMMS, Nazareth, Israel
| | - Riad Tome
- Department of Anesthesiology, Nazareth Hospital EMMS, Nazareth, Israel
| | - Haitam Zeibak
- Department of Anesthesiology, Nazareth Hospital EMMS, Nazareth, Israel
| | - Wisam Abboud
- Department of General Surgery, Nazareth Hospital EMMS, Nazareth, Israel
- Faculty of Medicine, Bar-Ilan University, Ramat Gan, Israel
| | - Amir Mari
- Gastroenterology and Endoscopy Unit, Nazareth Hospital EMMS, Nazareth, Israel
- Faculty of Medicine, Bar-Ilan University, Ramat Gan, Israel
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Sirbu O, Sorodoc V, Floria M, Statescu C, Sascau R, Lionte C, Petris OR, Haliga RE, Morariu PC, Tirnoveanu A, Burduloi VM, Ursulescu C, Sorodoc L. Nontrombotic Pulmonary Embolism: Different Etiology, Same Significant Consequences. J Pers Med 2023; 13:jpm13020202. [PMID: 36836436 PMCID: PMC9963227 DOI: 10.3390/jpm13020202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/16/2023] [Accepted: 01/20/2023] [Indexed: 01/26/2023] Open
Abstract
Nontrombotic pulmonary embolism represents the embolization of different types of materials (cells, organisms, gas, foreign material) into pulmonary circulation. The disease is uncommon, and clinical presentation together with laboratory findings are nonspecific. Its pathology is usually misdiagnosed based on imaging findings as pulmonary thromboembolism, but the correct diagnosis is essential because different therapeutic approaches are required. In this context, knowledge of the risk factors associated with nontrombotic pulmonary embolism and specific clinical symptoms is fundamental. Our objective was to discuss the specific features of the most common etiologies of nontrombotic pulmonary embolism, gas, fat, amniotic fluid, sepsis and tumors, to provide assistance for a rapid and correct diagnosis. Because the most common etiologies are iatrogenic, knowledge of the risk factors could be an important tool for prevention or rapid treatment if the disease develops during different procedures. The diagnosis of nontrombotic pulmonary embolisms represent a laborious challenge, and endeavors should be made to prevent development and increase awareness of this disease.
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Affiliation(s)
- Oana Sirbu
- Department of Internal Medicine, Clinical Emergency Hospital “Sfântul Spiridon”, 700111 Iasi, Romania
- Faculty of General Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 16 Universitatii Street, 700115 Iasi, Romania
| | - Victorita Sorodoc
- Department of Internal Medicine, Clinical Emergency Hospital “Sfântul Spiridon”, 700111 Iasi, Romania
- Faculty of General Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 16 Universitatii Street, 700115 Iasi, Romania
- Correspondence: (V.S.); (C.S.)
| | - Mariana Floria
- Department of Internal Medicine, Clinical Emergency Hospital “Sfântul Spiridon”, 700111 Iasi, Romania
- Faculty of General Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 16 Universitatii Street, 700115 Iasi, Romania
| | - Cristian Statescu
- Faculty of General Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 16 Universitatii Street, 700115 Iasi, Romania
- Department of Cardiology, Institute of Cardiovascular Diseases “Dr. George I.M. Georgescu”, 700503 Iasi, Romania
- Correspondence: (V.S.); (C.S.)
| | - Radu Sascau
- Faculty of General Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 16 Universitatii Street, 700115 Iasi, Romania
- Department of Cardiology, Institute of Cardiovascular Diseases “Dr. George I.M. Georgescu”, 700503 Iasi, Romania
| | - Catalina Lionte
- Department of Internal Medicine, Clinical Emergency Hospital “Sfântul Spiridon”, 700111 Iasi, Romania
- Faculty of General Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 16 Universitatii Street, 700115 Iasi, Romania
| | - Ovidiu Rusalim Petris
- Department of Internal Medicine, Clinical Emergency Hospital “Sfântul Spiridon”, 700111 Iasi, Romania
- Faculty of General Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 16 Universitatii Street, 700115 Iasi, Romania
| | - Raluca Ecaterina Haliga
- Department of Internal Medicine, Clinical Emergency Hospital “Sfântul Spiridon”, 700111 Iasi, Romania
- Faculty of General Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 16 Universitatii Street, 700115 Iasi, Romania
| | - Paula Cristina Morariu
- Department of Internal Medicine, Clinical Emergency Hospital “Sfântul Spiridon”, 700111 Iasi, Romania
- Faculty of General Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 16 Universitatii Street, 700115 Iasi, Romania
| | - Andreea Tirnoveanu
- Faculty of General Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 16 Universitatii Street, 700115 Iasi, Romania
| | - Vladut Mirel Burduloi
- Faculty of General Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 16 Universitatii Street, 700115 Iasi, Romania
| | - Corina Ursulescu
- Faculty of General Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 16 Universitatii Street, 700115 Iasi, Romania
- Department of Radiology, Clinical Emergency Hospital “Sfântul Spiridon”, 700111 Iasi, Romania
| | - Laurentiu Sorodoc
- Department of Internal Medicine, Clinical Emergency Hospital “Sfântul Spiridon”, 700111 Iasi, Romania
- Faculty of General Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 16 Universitatii Street, 700115 Iasi, Romania
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Zhang CMJ, Wang X. Suspected cerebrovascular air embolism during endoscopic esophageal varices ligation under sedation with fatal outcome: A case report. World J Clin Cases 2022; 10:371-380. [PMID: 35071541 PMCID: PMC8727279 DOI: 10.12998/wjcc.v10.i1.371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 11/19/2021] [Accepted: 11/30/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Air embolism is a very rare, yet serious and potentially fatal complication of digestive endoscopic treatment. Air embolism is the result of air directly entering the arteries or veins. However, to recognize neurological dysfunction under sedation can be difficult. Therefore, it is extremely important to identify high-risk groups and take preventive measures.
CASE SUMMARY Herein, we report a 74-year-old female patient with esophageal varices who suffered from consciousness disturbance after the third endoscopic ligation of esophageal varices under sedation. Combined with the patient’s imaging examination results and medical history, we highly suspected that the patient had developed paradoxical cerebral air embolism during endoscopic ligation. We learned that the patient died at a later follow-up. In order to be able to identify and prevent the occurrence of air embolism early, we summarize and analyze the risk factors, pathogenesis, clinical manifestations, prevention and treatment options of gastrointestinal endoscopy complicated by cerebral air embolism.
CONCLUSION Electroencephalographic monitoring helps to recognize the occurrence of air embolism in time and increase the patient's chance of survival.
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Affiliation(s)
- Cuo-Mao-Ji Zhang
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Xiao Wang
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
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Lee JH, Lee HY, Lim MK, Kang YH. Massive cerebral air embolism following percutaneous transhepatic biliary drainage: A case report. Medicine (Baltimore) 2021; 100:e28389. [PMID: 34967372 PMCID: PMC8718232 DOI: 10.1097/md.0000000000028389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 12/02/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Cerebral air embolism from portal venous gas rarely occurs due to invasive procedures (e.g., endoscopic procedures, liver biopsy, or percutaneous transhepatic biliary drainage) that disrupt the gastrointestinal or hepatobiliary structures. Here, we report a rare case of fatal cerebral air embolism following a series of percutaneous transhepatic biliary drainage tube insertions. PATIENT CONCERNS A 50-year-old woman with a history of cholecystectomy, liver wedge resection, and hepaticojejunostomy for gallbladder cancer presented with altered mental status 1 week after percutaneous transhepatic biliary drainage tube placement. DIAGNOSES Extensive cerebral air embolism and acute cerebral infarction. INTERVENTIONS Brain computed tomography and magnetic resonance imaging, hyperbaric oxygen therapy, medical therapy. OUTCOMES Despite the use of hyperbaric oxygen therapy and medical treatment including vasopressors, the patient eventually died due to massive systemic air embolism. LESSONS To date, there have been no reports of cerebral air embolism due to percutaneous transhepatic biliary drainage with pronounced radiologic images. We reviewed previously reported fatal cases associated with endoscopic hepatobiliary procedures and assessed the possible mechanisms and potential causes of air embolism.
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Ekmektzoglou K, Alexandrakis G, Dimopoulos K, Tsibouris P, Kalantzis C, Vlachou E, Apostolopoulos P. When in Trouble Think of the Bubble: Paradoxical Cerebral Arterial Gas Embolism after Endoscopic Retrograde Cholangiopancreatography. Case Rep Gastroenterol 2021; 15:456-469. [PMID: 34054400 PMCID: PMC8138231 DOI: 10.1159/000514706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 01/22/2021] [Indexed: 11/19/2022] Open
Abstract
Air embolism (a result of direct communication with the vasculature and an external pressure gradient from the gastrointestinal or the biliary tract), although rare, is a potentially devastating adverse event seen in endoscopic retrograde cholangiopancreatography (ERCP) procedures. Whether venous, arterial, or paradoxical, the clinical presentation ranges from asymptomatic patients to cardiorespiratory arrest. This is of particular importance because it makes the diagnosis of air embolism even more difficult in an already sedated patient. Since early recognition increases the chances of patients' survival, endoscopists should be highly motivated and trained to recognize this complication as early as possible. With only 60 cases of air embolism reported (and even fewer related to paradoxical air embolism), we aimed to report a case of paradoxical cerebral air embolism in a patient undergoing ERCP due to a common bile duct stricture and to provide a mini-review of this clinical entity that can serve as a bedside quick reference guide for endoscopists worldwide.
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Affiliation(s)
- Konstantinos Ekmektzoglou
- School of Medicine, European University Cyprus, Nicosia, Cyprus.,Department of Gastroenterology, Army Share Fund Hospital, Athens, Greece
| | | | | | | | | | - Erasmia Vlachou
- Department of Gastroenterology, Army Share Fund Hospital, Athens, Greece
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