Popa Daniel, Grover Ian, Hayden Stephen, Witucki Peter
Department of Emergency Medicine, University of California-San Diego, San Diego, California; Division of Hyperbaric Medicine, University of California-San Diego, San Diego, California.
J Emerg Med. 2019 Nov;57(5):683-688. doi: 10.1016/j.jemermed.2019.08.053. Epub 2019 Oct 28.
Arterial gas embolus (AGE) is a rare complication of esophagoduodenoscopy (EGD) that has been described in only a few case reports in the literature. The exact etiology remains unknown, but many of the cases share some common characteristics.
We report the case of a 52-year-old otherwise healthy man who underwent outpatient EGD for a sensation of retained food in his esophagus. During the procedure, he suffered a tonic-clonic seizure, bradycardia, and hypoxia. Subsequent emergency department workup showed pneumocephalus on computed tomography brain imaging, and he was diagnosed with a cerebral AGE (CAGE). He was transferred to our facility for treatment of CAGE with hyperbaric oxygen therapy (HBOT). After multiple hyperbaric treatments, he was discharged with a residual left hemiparesis, which represented a significant improvement in his overall neurologic status. We also present a review of similar EGD CAGE cases from the literature and discuss their outcomes and the need for HBOT. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Although CAGE from EGD is rare, these patients will often be transferred to the ED from gastrointestinal procedural suites and an emergency physician should understand that an iatrogenic CAGE can result from this procedure and that CAGE is a clinical diagnosis. Definitive care at a critical care-capable hyperbaric chamber will provide the patient with the best chance of meaningful recovery, and transport should be arranged as expeditiously as possible.
动脉气体栓塞（AGE）是食管十二指肠镜检查（EGD）的一种罕见并发症，文献中仅有少数病例报告对此进行过描述。确切病因尚不清楚，但许多病例具有一些共同特征。
我们报告一例52岁的健康男性病例，该患者因食管内有食物残留感而接受门诊EGD检查。在检查过程中，他出现了强直阵挛性发作、心动过缓和缺氧。随后在急诊科进行的检查显示，脑部计算机断层扫描成像发现有气颅，他被诊断为脑AGE（CAGE）。他被转至我们的机构接受高压氧治疗（HBOT）以治疗CAGE。经过多次高压治疗后，他出院时仍有左侧偏瘫残留，但这代表其整体神经功能状态有了显著改善。我们还对文献中类似的EGD-CAGE病例进行了综述，并讨论了它们的治疗结果以及HBOT的必要性。急诊医生为何应了解这一点？：尽管EGD导致的CAGE很罕见，但这些患者通常会从胃肠检查室转至急诊科，急诊医生应明白该检查可能导致医源性CAGE，且CAGE是一种临床诊断。在具备重症监护能力的高压氧舱进行确定性治疗将为患者提供实现有意义康复的最佳机会，应尽快安排转运。
