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Case Reports
. 2010 Mar;51(2):287-90.
doi: 10.3349/ymj.2010.51.2.287. Epub 2010 Feb 12.

Fatal biliary-systemic air embolism during endoscopic retrograde cholangiopancreatography: a case with multifocal liver abscesses and choledochoduodenostomy

Sung Tae Cha  1 , Chang-Il Kwon, Han Gyung Seon, Kwang Hyun Ko, Sung Pyo Hong, Seong Gyu Hwang, Pil Won Park, Kyu Sung Rim
Affiliations
Case Reports

Fatal biliary-systemic air embolism during endoscopic retrograde cholangiopancreatography: a case with multifocal liver abscesses and choledochoduodenostomy

Sung Tae Cha et al. Yonsei Med J. 2010 Mar.

Abstract

We report a rare case of a massive fatal embolism that occurred in the middle of endoscopic retrograde cholangiopancreatography (ERCP) and retrospectively examine the significant causes of the event. The patient was a 50-year old female with an uncertain history of previous abdominal surgery for multiple biliary stones 20 years prior. The patient presented with acute right upper quadrant pain. An abdominal computed tomographic (CT) scan revealed the presence of multiple stones in the common bile duct (CBD) and intra-hepatic duct (IHD) with biliary obstruction, multifocal liver abscesses, and air-biliarygram. Emergency ERCP showed a wide and straight opening of choledochoduodenostomy, which may have been created during a previous surgery, and multiple filling defects in the CBD. With the use of a forward endoscope, mud stones were extracted through the opening of the choledochoduodenostomy. Cardiac arrest suddenly developed during the procedure, and despite immediate resuscitation, the patient died due to a massive systemic air embolism. We reviewed previously reported fatal cases and accessed factors facilitating air embolisms in this case.

Keywords: Air embolism; ERCP; choledochoduodenostomy; sphincterotomy.

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Conflict of interest statement

The authors have no financial conflicts of interest.

Figures

Fig. 1
Fig. 1
Abdominal CT scan showing multiple stones in the CBD and IHD with biliary obstruction, multifocal liver abscesses, and air-biliarygram. CBD, common bile duct; IHD, intra-hepatic duct.
Fig. 2
Fig. 2
ERCP showing the wide and straight opening of a choledochoduodenostomy (arrow). ERCP, endoscopic retrograde cholangiopancreatography.
Fig. 3
Fig. 3
Brown-pigmented mud stones (arrow) were being extracted with the forward endoscope.
Fig. 4
Fig. 4
Chest X-ray taken at the scene revealing air density occupied in heart chambers (arrow) and hepatic vasculatures and splenic vein (arrow heads) indicating a massive air embolism.
See this image and copyright information in PMC

References

    1. Nayagam J, Ho KM, Liang J. Fatal systemic air embolism during endoscopic retrograde cholangio-pancreatography. Anaesth Intensive Care. 2004;32:260–264. - PubMed
    1. Christi SU, Scheppach W, Peters U, Kirchner T. Cerebral air embolism after gastroduodenoscopy: complication of a duodenocaval fistula. Gastrointest Endosc. 1994;40:376–378. - PubMed
    1. Raju GS, Bcndixen BH, Khan J, Summers RW. Cerebrovascular accident during endoscopy: consider cerebral air embolism, a rapidly reversible event with hyperbaric oxygen therapy. Gastrointest Endosc. 1998;47:70–73. - PubMed
    1. Akhtar N, Jafri W, Mozaffar T. Cerebral artery air embolism following an esophagogastroscopy: a case report. Neurology. 2001;56:136–137. - PubMed
    1. Kennedy C, Larvin M, Linsell J. Fatal hepatic air embolism following ERCR. Gastrointest Endosc. 1997;45:187–188. - PubMed

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