Analysis of Tomographic Images of a Catastrophic Gas Embolism during Endoscopic Retrograde Cholangiopancreatography

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...

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Bibliographic Details
Published in:Diagnostics (Basel) 2024-07, Vol.14 (13), p.1425
Main Authors: Frydrych, Marta, Łukaszewski, Marceli, Nelke, Kamil, Janeczek, Maciej, Małyszek, Agata, Nienartowicz, Jan, Gogolewski, Grzegorz, Dobrzyński, Maciej
Format: Article
Language:English
Subjects:
Bile ducts
Bubbles
Carbon dioxide
Cardiac arrest
Cardiopulmonary resuscitation
CPR
Embolisms
Endoscopy
ERCP
gas embolism
Kinases
Medical imaging
Pulmonary arteries
pulmonary embolism
SCA
Small intestine
Tomography
Veins & arteries
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Summary: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.
ISSN:2075-4418
2075-4418
DOI:10.3390/diagnostics14131425