Jain Aditya K, Goel Nikita, Mathur Kushagra
General Medicine, Hillingdon Hospital NHS Foundation Trust, London, GBR.
Rheumatology, Northwick Park Hospital, Harrow, GBR.
Cureus. 2024 Oct 16;16(10):e71603. doi: 10.7759/cureus.71603. eCollection 2024 Oct.
This case report explores the complex clinical trajectory of a 72-year-old female with a history of hypertension, iron-deficiency anaemia, and vertigo, who underwent an endoscopic retrograde cholangiopancreaticography (ERCP) procedure for common bile duct (CBD) stone removal. After an uneventful laparoscopic cholecystectomy, she continued to experience abdominal pain and icterus. Investigations including magnetic resonance cholangiopancreatography (MRCP), revealed a dilated CBD with multiple stones, prompting ERCP. During the procedure, a fall in saturation and arrhythmia were noted, leading to the diagnosis of gas embolism. Trans-esophageal echocardiography (TEE) confirmed air bubbles in cardiac chambers and a patent foramen ovale (PFO). Despite interventions, including intubation, noradrenaline infusion, and a temporary pacemaker, the patient's cardiovascular status deteriorated. Due to financial constraints, she was discharged against medical advice (DAMA) with a high-risk profile. This case highlights the rarity and iatrogenic nature of ERCP-related air embolism, emphasising the challenges in its management and underscoring the need for awareness and timely intervention. The discussion delves into the broader context of air embolism pathogenesis, referencing relevant literature and highlighting the need for continued research in managing such rare complications associated with ERCP.
本病例报告探讨了一名72岁女性的复杂临床病程，该患者有高血压、缺铁性贫血和眩晕病史，因胆总管（CBD）结石行内镜逆行胰胆管造影术（ERCP）。在顺利进行腹腔镜胆囊切除术后，她仍持续出现腹痛和黄疸。包括磁共振胰胆管造影（MRCP）在内的检查显示胆总管扩张且有多个结石，遂行ERCP。术中发现饱和度下降和心律失常，诊断为气体栓塞。经食管超声心动图（TEE）证实心腔内有气泡及卵圆孔未闭（PFO）。尽管采取了包括插管、去甲肾上腺素输注和临时起搏器等干预措施，患者的心血管状况仍恶化。由于经济限制，她在高危情况下自行出院（AMA）。本病例突出了ERCP相关空气栓塞的罕见性和医源性，强调了其管理中的挑战，并强调了提高认识和及时干预的必要性。讨论深入探讨了空气栓塞发病机制的更广泛背景，参考了相关文献，并强调了在处理与ERCP相关的此类罕见并发症方面持续研究的必要性。
