Subcutaneous Emphysema, Pneumothorax and Pneumomediastinum Following Endoscopic Sphincterotomy

Right pneumothorax, pneumomediastinum, pneumoperitoneum, pneumoretroperitoneum, and subcutaneous emphysema as rare complications after ERCP: a case report

Endoscopic retrograde cholangiopancreatography is a complex procedure with a significant risk of severe consequences. We herein report a 56-year-old Middle Eastern female who was diagnosed with acute ascending cholangitis. Endoscopic retrograde cholangiopancreatography was performed with gallstone absorption and stent implanting. However, the patient developed significant pneumothorax; pneumomediastinum, pneumoperitoneum, pneumoretroperitoneum, and subcutaneous emphysema of the abdomen, chest, right arm and shoulder, face and right orbital area. Radiological studies demonstrated no evidence of perforation on bowel obstruction. The patient was treated successfully with good results and post-operative follow-up was unremarkable. In conclusion, air leakage following endoscopic retrograde cholangiopancreatography without evidence of perforation is extremely rare. While pneumothorax development usually requires thoracostomy; pneumomediastinum, pneumoperitoneum, pneumoretroperitoneum, and subcutaneous emphysema are usually treated conservatively.

Gas spread following endoscopic sphincterotomy: Challenging diagnosis and management: A case reports

INTRODUCTION AND IMPORTANCE

Subcutaneous emphysema, pneumomediastinum and pneumoperitoneum simultaneously are a rare complication of endoscopic retrograde cholangiopancreatography (ERCP) that usually indicates free perforation to the peritoneal cavity or the retroperitoneal space.

CASE PRESENTATION

We report an unusual case of a subcutaneous emphysema, pneumomediastinum and pneumoperitoneum following an ERCP for removal of a common bile duct stone. There was no radiological evidence of peritoneal or retroperitoneal perforation.

CLINICAL DISCUSSION

This complication seems to be relative to duodenal perforation. However, hypotheses of transdiaphragmatic pressure effects and gas diffusion within the mucosa are discussed in the literature pneumomediastinum and pneumoperitoneum, must be recognized, because it is benign and needs exceptionally surgical or radiological intervention. Management of this adverse event depends on type of perforation and clinical presentation.

CONCLUSION

ERCP has facilitated innovative diagnosis and treatment of pancreatobiliary tract diseases. Nevertheless, some complications may occur such gas diffusion in the peritoneal cavity or the retroperitoneal space with or without perforation. Our case our case illustrates such incidents could be benign, self-limited and need no intervention.

Bilateral pneumothorax: The cause of hypoxia during endoscopic retrograde cholangiopancreatography

Background:

Endoscopic retrograde cholangiopancreatography (ERCP) is recognized as a significant diagnostic and therapeutic procedure for the administration of different pancreatic and biliary problems. This procedure runs a considerable risk of complications despite its substantial safety. The rate of significant inconveniences is reported to range from 5.4% to 23.0% and the general mortality from 0.1 to 1%. Post-ERCP pneumothorax is an uncommon complication that is usually underestimated

Case Presentation:

In the present study, we report a 65-year-old woman who develops hypoxemia during the ERCP. Based on the obtained results, it was revealed that this patient had perforation-related bilateral pneumothorax and hypoxemia.

Conclusion:

Based on the obtained results, it was revealed that this patient had perforation-related bilateral pneumothorax and hypoxemia.

Subcutaneous emphysema, pneumothorax, pneumomediastinum and pneumoperitoneum after upper gastrointestinal endoscopy

Upper gastrointestinal (GI) endoscopies are performed for several reasons. The overuse of endoscopy has negative effects on the quality of healthcare and pressurises endoscopy services. It also results in the complications. These complications include pneumoperitoneum, pneumomediastinum and subcutaneous pneumomediastinum. However, it is worth noting that these complications rarely occur during endoscopy of the upper GI tract. These complications, when they occur, indicate perforation of the retroperitoneal space or peritoneal cavity. In this article, we discuss a case of pneumoperitoneum, pneumomediastinum and subcutaneous emphysema after upper GI endoscopy.

Periorbital and Mediastinal Emphysema after Upper Gastrointestinal Endoscopy: Case Report of a Rare Complication

Purpose:

To report a rare case of periorbital emphysema concurrent with cervicofacial and mediastinal emphysema in an elderly woman who underwent upper gastrointestinal endoscopy for chronic liver disease.

Case Report:

An elderly woman with decompensated chronic liver disease presented with features of periorbital, facial, and mediastinal emphysema, characterized with crepitant swelling over the right periorbital area, face, neck, and mediastinum after undergoing upper gastrointestinal endoscopy. There was no history of trauma or Valsalva maneuver. Ocular findings were stable with no evidence of orbital compartmental syndrome. Urgent computed tomography scans of the orbit and chest were performed, and emergency systemic treatment with nasogastric decompression and antibiotics was initiated. However, she suddenly collapsed and succumbed despite all resuscitative efforts.

Conclusion:

Our case demonstrates that periorbital emphysema can occur following procedures such as upper gastrointestinal endoscopy, in the eyes without history of local trauma. This complication should be suspected especially if there is associated cervicofacial and mediastinal emphysema. Subcutaneous emphysema is usually self-resolving; however, extension of air into deeper planes can cause dangerous complications such as blindness due to orbital emphysema or mortality due to mediastinal emphysema. Hence, prompt diagnosis and urgent intervention are crucial to avoid vision and life threatening complications.

Pneumothorax following ERCP: report of four cases and review of the literature

We report four patients with pneumothorax as a complication of ERCP with sphincterotomy. With conservative treatment all patients recovered. Previously, 16 comparable cases have been reported in the literature. The main risk factor for this rare complication seems (pre-cut) sphincterotomy. Pneumothorax is usually right-sided or bilateral and accompanied by pneumomediastinum, pneumoretroperitoneum and subcutaneous emphysema. The prognosis seems favourable with a non-surgical approach including intravenous antibiotics, fasting and when indicated chest tube drainage.