An autopsy case of systemic air embolism during endoscopic treatment for a duodenal ulcer

Abstract

A 61-year-old man with liver cirrhosis admitted our hospital because of hematemesis. Gastroduodenal endoscopy revealed duodenal ulcer with exposed vessel covered with clot but showed no active bleeding. Since his general condition was poor because of severe liver cirrhosis and hepatic encephalopathy, we did not perform clipping. At the fourth day after admission his consciousness and general condition was improved, thus we reperformed gastroduodenal endoscopy and we found exposed vessel covered with fresh clot at the ulcer. Because it was considered to be a sign of impending bleeding, clipping was performed ; however, severe hemorrhage occurred. Despite of added clips and injection of HSE, bleeding continued. Then sudden cardiopulmonary arrest occurred. The CT for autopsy revealed the gas in the systemic blood vessels. The autopsy revealed duodenoportal fistula and air embolism in the whole body ; however, no intracardiac shunt was found. Air embolism during endoscopy is very rare and unpredictable, but once occurred, it is very critical. If the patient status deteriorate during endoscopy, we should be aware of this complication.