Air embolism case following ERCP

Abstract

Air embolism is a very rare endoscopic complication (occurs in 1 of 6000 – 8000 procedures) but possesses the potential to be severe and fatal. It is most commonly associated with an ERCP, but it can result from any endoscopic procedure including an gastroscopy, enteroscopy, an EUS, a colonoscopy. Risk factors are previous interventions or surgeries of the bile duct system, transhepatic portosystemic shunt, percutaneous transhepatic biliary drains, blunt or penetrating trauma to the liver, inflammation of the digestive system, sphincterotomy, stent placement, hepatic abscesses or tumors. The patient was a 53-year old female with history of previous acut pencreatitis and abdominal surgery for multiple abscesses and cholecystectomy, ERCP with EST and biliary plastic stent placement. During the procedure we exchanged the former biliary plastic stent. The cardiovascular and neurological symptoms appeared when the patient was repositioned from prone to supine position at the end of the procedure. Computer tomography showed air in vena femoralis communis. The patient's condition improved rapidly in the ICU. In summary, endoscopists should be aware of the signs and symptoms of an air embolism. In patients with risk factors, prophylactic measures can be applied. Increased awareness is essential for prompt recognition of the air embolism, which can allow potentially life-saving therapy to be provided.