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Case Report
Systemic air embolism during endoscopic retrograde cholangiopancreatography with myocardial and cerebral ischemia
1 MD, Department of Internal Medicine, University Hospital Osijek, Osijek, Croatia
2 Faculty of Medicine, University J.J. Strossmayera Osijek, Osijek, Croatia
3 MD and PhD, Department of Internal Medicine, University Hospital Osijek, Osijek, Croatia
Address correspondence to:
Lana Maričić
Department of Internal Medicine, University Hospital Osijek, J. Huttlera 4, Osijek,
Croatia
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Article ID: 101075Z01DM2019
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Mihić D, Marićič L, Loinjak D. Systemic air embolism during endoscopic retrograde cholangiopancreatography with myocardial and cerebral ischemia. Int J Case Rep Images 2019;10:101075Z01DM2019.ABSTRACT
Introduction: Endoscopic retrograde cholangiopancreatography (ERCP) has become the primary tool for the treatment of biliary and pancreatic stone diseases. Systemic air embolisms are a rare, but often a fatal complication of ERCP.
Case Report: We present a 56-year-old woman, who was hospitalized for routine, elective ERCP due to recurrent cholangitis. The procedure complicated by development systemic air embolism with myocardial and cerebral ischemia. A transesophageal ultrasound was confirmed patent foramen ovale (PFO). Magnetic resonance imaging (MRI) of brain was done and it showed numerous zones of relatively fresh ischemic lesions through both hemispheres of the brain. The patient has survived but with serious consequences. One year after the incident, the patient presented with paresis of the right hand, walking with the assistance.
Conclusion: Systemic air embolism presents a rare, but lifethreatening complication, particularly with persons at an increased risk, that is, with a left-to-right shunt.
Keywords: Air embolism, Cerebral ischemia, Endoscopic retrograde cholangiopancreatography, Myocardial infarction
SUPPORTING INFORMATION
Author Contributions
Damir Mihić - Substantial contributions to conception and design, Analysis of data, Revising it critically for important intellectual content, Final approval of the version to be published
Lana Maričić - Substantial contributions to conception and design, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Domagoj Loinjak - Substantial contributions to conception and design, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2019 Damir Mihić et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
