Frydrych Marta, Łukaszewski Marceli, Nelke Kamil, Janeczek Maciej, Małyszek Agata, Nienartowicz Jan, Gogolewski Grzegorz, Dobrzyński Maciej
Sokolowski Specialist Hospital in Walbrzych, Sokolowski, 58-309 Walbrzych, Poland.
Private Practice of Maxillo-Facial Surgery and Maxillo-Facial Surgery Ward, EMC Hospital, Pilczycka 144, 54-144 Wrocław, Poland.
Diagnostics (Basel). 2024 Jul 3;14(13):1425. doi: 10.3390/diagnostics14131425.
Endoscopic retrograde cholangiopancreatography (ERCP) is a commonly performed minimally invasive procedure. Air embolism in a patient undergoing ERCP is relatively rare, accounting for approximately 2-3% of procedures performed, and a catastrophic air embolism is even rarer. Symptoms of air embolism can come from the cardiopulmonary and nervous system. It is important to remember this in the differential diagnosis of complications of ERCP, as early detection is crucial. In the case presented here, the diagnostic CT scan performed immediately after the incident brings awareness of how massive an air embolism can be. The CT results showed gas bubbles entering both the superior and inferior vena cava. The presence of air has been captured in the bile ducts, duodenum wall, heart, femoral veins and intracranially. Risk factors for this complication include previous biliary surgeries, the presence of prostheses and stents, cholangitis, liver tumors and anatomical anomalies such as hepatobiliary fistulas, as well as intrahepatic and extrahepatic anatomical leaks. As gas embolism is associated with serious health consequences, knowledge of the problem and adequate preparation may reduce the occurrence of the problem. Attention should be paid to basic and easily obtainable precautions when performing the procedure, such as the patient's hemodynamic status, adequate hydration and positioning during the procedure.
内镜逆行胰胆管造影术（ERCP）是一种常用的微创手术。接受ERCP的患者发生空气栓塞相对少见，约占所施行手术的2% - 3%，而灾难性空气栓塞更为罕见。空气栓塞的症状可源自心肺和神经系统。在ERCP并发症的鉴别诊断中牢记这一点很重要，因为早期检测至关重要。在此呈现的病例中，事件发生后立即进行的诊断性CT扫描让我们意识到空气栓塞可能会有多严重。CT结果显示气泡进入上腔静脉和下腔静脉。在胆管、十二指肠壁、心脏、股静脉及颅内均发现有空气存在。该并发症的危险因素包括既往胆道手术史、存在假体和支架、胆管炎、肝肿瘤以及诸如肝胆瘘等解剖学异常，还有肝内和肝外解剖学渗漏。由于气体栓塞会带来严重的健康后果，了解该问题并做好充分准备可能会减少该问题的发生。在施行该手术时应注意基本且易于采取的预防措施，如患者的血流动力学状态、术中充分补液及体位摆放。
