Shin So Young, Yeon Hee Jin, Lee Sang On, Lee Jeong Rim, Leem Galam, Han Seok Joo
Division of Pediatric Surgery, Department of Surgery, Severance Children's Hospital, Yonsei University College of Medicine, Seoul 03722, Seodaemun-gu, South Korea.
Department of Surgery, Konyang University College of Medicine, Daejeon 35365, Seo-Gu, South Korea.
World J Gastrointest Endosc. 2025 Jul 16;17(7):105773. doi: 10.4253/wjge.v17.i7.105773.
Air embolism (AE) is a rare but potentially fatal complication of intestinal endoscopy (IE).
Herein, we report the case of an 18-year-old woman who underwent a successful Kasai portoenterostomy (KPE) for biliary atresia but died of AE during intraoperative IE for stone removal at the portoenterostomy site. Our review of the English literature identified only four similar cases of fatal AE during IE in patients undergoing KPE. The common clinical setting in the five patients, including our case, was high-pressure air insufflation into the blind closed afferent loop of the KPE to secure visibility. We hypothesize that the highly pressurized air injected into the closed loop entered the bile canaliculi-previously opened by KPE for bile drainage-passed through the tiny, microscopic pores of the fenestrated liver sinusoid endothelial cells, and finally entered the bloodstream with ease, resulting in fatal AE.
Meticulous performance of IE, especially on the KPE blind loop, is warranted owing to the risk of AE.
空气栓塞（AE）是肠道内镜检查（IE）中一种罕见但可能致命的并发症。
在此，我们报告一例18岁女性病例，该患者因胆道闭锁接受了成功的肝门空肠吻合术（KPE），但在术中于肝门空肠吻合部位进行内镜取石时死于空气栓塞。我们对英文文献的回顾仅发现4例在接受KPE的患者进行IE期间发生致命性AE的类似病例。包括我们的病例在内，这5例患者的常见临床情况是向KPE的盲端闭合输入袢内高压注入空气以确保视野清晰。我们推测，注入闭合肠袢的高压空气进入了先前因胆汁引流而由KPE打开的胆小管，穿过有窗孔的肝血窦内皮细胞的微小、微观孔隙，最终轻松进入血液循环，导致致命性AE。
由于存在空气栓塞风险，因此在进行肠道内镜检查时，尤其是对KPE盲袢进行检查时，必须谨慎操作。
