Fernandez-Fernandez J, Real-Noval H, Rodriguez-Rodriguez E
Hospital Universitario Marques de Valdecilla, Santander, Espana.
Rev Neurol. 2016 Dec 1;63(11):497-500.
Cerebral air embolism following endoscopic processes is an infrequent complication, but can have catastrophic consequences.
An 85-year-old male diagnosed with distal cholangiocarcinoma with criteria for unresectability who was submitted to placement of a biliary drainage prosthesis. Endoscopic retrograde cholangiopancreatography was performed to change the prosthesis. After the procedure, the patient's vital signs and level of consciousness underwent a decline, and orotracheal intubation was required. A computerised axial tomography scan of the head showed evidence of a massive air embolism with focal points of hyperacute ischaemia in both hemispheres. The patient later died.
Cerebral air embolism following endoscopic retrograde cholangiopancreatography is infrequent, but potentially lethal. Manipulation of the bilio-intestinal wall in endoscopic examinations could give rise to communications between the lumen and the venous system. This, together with the high insufflation pressure used to conduct this test, would condition the passage of air to the portal venous system, and from there to the circulatory system. In the central nervous system, air bubbles would lead to a vascular obstruction, with the subsequent ischaemia and necrosis of tissues. An early diagnosis and life support therapy are essential. Its timely management can contribute to a better prognosis which, at least initially, is gloomy.
内镜检查后发生脑空气栓塞是一种罕见的并发症，但可能产生灾难性后果。
一名85岁男性被诊断为远端胆管癌，符合不可切除标准，接受了胆道引流假体置入术。为更换假体进行了内镜逆行胰胆管造影术。术后，患者的生命体征和意识水平下降，需要进行气管插管。头部计算机断层扫描显示有大量空气栓塞的证据，双侧半球有超急性缺血灶。患者随后死亡。
内镜逆行胰胆管造影术后发生脑空气栓塞虽不常见，但有潜在致命性。内镜检查中对胆肠壁的操作可能导致管腔与静脉系统之间形成连通。这与进行该检查时使用的高充气压力一起，会使空气进入门静脉系统，进而进入循环系统。在中枢神经系统中，气泡会导致血管阻塞，随后组织缺血坏死。早期诊断和生命支持治疗至关重要。其及时处理有助于改善预后，至少在最初阶段，预后是悲观的。
