Fatal Cerebral Air Embolism Due to a Patent Foramen Ovale during Endoscopic Retrograde Cholangiopancreatography
| Autor: | Claudia Stöllberger, Josef Finsterer, Adam Bastovansky |
|---|---|
| Rok vydání: | 2013 |
| Předmět: |
medicine.medical_specialty
Endoscopic retrograde cholangiopancreatography medicine.diagnostic_test business.industry Intracranial pressure Gastroenterology Medicine (miscellaneous) Case Report Endoscopy Anastomosis medicine.disease Air embolism Surgery Embolism Bacteremia Brain edema medicine Patent foramen ovale Radiology Nuclear Medicine and imaging Embolism air business Complication |
| Zdroj: | Clinical Endoscopy |
| ISSN: | 2234-2400 |
| Popis: | Fatal air embolism to the cerebrum during an endoscopic retrograde cholangiopancreatography (ERCP) has not been reported in a patient with a biliodigestive anastomosis and multiresistant extended-spectrum β-lactamase Escherichia coli (ESBL) bacteremia. A 59-year-old woman with a history of laparoscopic cholecystectomy and iatrogenic injury of the right choledochal duct, choledochojejunostomy (biliodigestive anastomosis), recurrent cholangitis, revision of the biliodigestive anastomosis, recurrent liver abscesses, and recurrent stenting of stenotic bile ducts, was admitted because of fever and tenderness of the right upper quadrant. On ERCP, a previously deployed covered Wallstent was replaced. Blood cultures grew ESBL. After stent removal 8 days later, the patient did not wake up and developed arterial hypotension and respiratory insufficiency, requiring mechanical ventilation. Computed tomography scans showed extensive air embolism to the liver, heart, and cerebrum. She died 1 day later. Although the exact pathogenesis of the fatal cerebral air embolism remains speculative, the nonphysiological anatomy and chronic infection with ESBL may have been contributory factors. |
| Databáze: | OpenAIRE |
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