Neofytou Kyriakos, Petrou Athanasios, Savva Constantinos, Petrides Christos, Andreou Charalampos, Felekouras Evangelos, Loizou Sakis
Department of Surgery, Nicosia Government Hospital, Palaios Dromos Lefkosias-Lemesou, No. 215, Strovolos, 2029 Nicosia, Cyprus.
Case Rep Med. 2013;2013:206564. doi: 10.1155/2013/206564. Epub 2013 Jun 24.
In the last thirty years, the widespread use of endoscopic retrograde cholangiopancreatography (ERCP) has radically changed the management of patients with diseases of the extrahepatic biliary tract and pancreas. Pneumothorax is a rare complication of ERCP. We report two cases of pneumothorax following elective ERCP for ductal stone clearance. The first patient was a 45-year-old female, who developed respiratory distress, abdominal pain, and profoundly abdominal distention immediately after the procedure. Imaging studies revealed the presence of a right-side pneumothorax, pneumomediastinum, pneumoperitoneum, and pneumoretroperitoneum. The second patient was a 94-year-old female, who developed tension pneumothorax with clinical signs of shock during the procedure. Imaging studies revealed the presence of a right-side pneumothorax without free air in the mediastinum and retroperitoneal space. The imaging findings suggest that the occurrence of this rare complication in our patients was caused by entirely different pathophysiological mechanisms. Both patients were successfully treated with chest tube insertion, and no further intervention was required. Clinicians should be aware of this serious complication because delayed diagnosis may involve significant morbidity and mortality risks.
在过去三十年中，内镜逆行胰胆管造影术（ERCP）的广泛应用从根本上改变了肝外胆道和胰腺疾病患者的治疗方式。气胸是ERCP的一种罕见并发症。我们报告两例因择期ERCP清除胆管结石后发生气胸的病例。首例患者为一名45岁女性，术后立即出现呼吸窘迫、腹痛及明显腹胀。影像学检查显示右侧气胸、纵隔积气、气腹及腹膜后积气。第二例患者为一名94岁女性，术中出现张力性气胸并伴有休克的临床体征。影像学检查显示右侧气胸，纵隔和腹膜后间隙无游离气体。影像学表现提示我们这两名患者发生这种罕见并发症的病理生理机制完全不同。两名患者均通过插入胸管成功治愈，无需进一步干预。临床医生应意识到这种严重并发症，因为延迟诊断可能会带来显著的发病和死亡风险。
