A Case Report of Cerebral Air Embolism after Esophagogastroduodenoscopy: Diagnosis and Management in the Emergency Department

Pandurangadu, Ananda Vishnu; Paul, Jose A.P.; Barawi, Mohammed; Irvin, C.B.

doi:10.1016/j.jemermed.2010.11.031

Cited by 17 publications

(11 citation statements)

References 26 publications

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“…These have occurred in patients with erosive esophagitis, 67 peptic ulceration with consequent GI tract vascular fistulas, 68,69 in patients who have undergone prior biliary surgery (the Kasai procedure) 70 or who have pre-existing percutaneous transhepatic drainage catheters, 71 and after ablation of duodenal arteriovenous malformations. 72 Air embolization also has been reported after EUS with FNA, 73 small-bowel endoscopy, 74 colonoscopy, 75 and sigmoidoscopy. 76 Several authors recommend the use of CO 2 instead of room air as an insufflation agent during endoscopy because of the rapid tissue absorption of CO 2 , in the event that gas embolism takes place.…”

Section: Safetymentioning

confidence: 96%

The use of carbon dioxide in gastrointestinal endoscopy

Lo¹,

Fujii-Lau²,

Enestvedt³

et al. 2016

Gastrointestinal Endoscopy

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Section: Safetymentioning

confidence: 96%

The use of carbon dioxide in gastrointestinal endoscopy

Lo¹,

Fujii-Lau²,

Enestvedt³

et al. 2016

Gastrointestinal Endoscopy

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“…As in earlier reports on ERCP or esophagogastroduodenoscopy-associated CAE, it is speculated that inflammation of the bile duct and its surrounding veins, previous intervention of the bile duct system, and insufflation of air during endoscopy may have contributed to air entering the vascular system either via portal and liver veins or via mucosal disruptions (Pandurangadu et al 2012; Nern et al 2012; Koster et al 2012). If air entered the arterial cerebral circulation, gas bubbles obstruct the cerebral vessels and cause distal ischemia (Muth and Shank 2000) via a complex cascade of damage (van Hulst et al 2003) which resembles damage resulting from hypoxic brain injury (Bäuerle et al 2013).…”

Section: Discussionmentioning

confidence: 87%

Cerebral air embolism via port catheter and endoscopic retrograde cholangio-pancreatography

et al. 2013

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BackgroundCerebral air embolism (CAE) is a critical clinical condition necessitating rapid diagnosis and therapeutic measures.MethodsThe authors describe two patients with lethal CAE.ResultsAn 81-year-old man rapidly developed coma with tetraplegia. CT-scan revealed prominent CAE whereby the entry of the air was via a port catheter for parenteral nutrition. A 45-year-old man with severe alcohol-toxic multiple organ damage needed endoscopic retrograde cholangio-pancreatography (ERCP) and a second esophagogastroscopy. After an epileptic seizure, the CT-scan of the brain showed small amounts of cerebral air in the posterior right hemisphere and in the sagittal superior sinus. Despite critical care the patient died.ConclusionCAE is a neurocritical emergency case. Early CT-scan of the brain can detect air, guide further therapy, and contribute to the assessment of the prognosis.

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“…It is thought that air insufflation required for EGD creates pressure gradient favoring passage of air into the vasculature [16, 17]. …”

Section: Discussionmentioning

confidence: 99%

Fatal Cerebral Air Embolism: A Case Series and Literature Review

Mishra

Reddy

Khaja

2016

Case Reports in Critical Care

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Cerebral air embolism (CAE) is an infrequently reported complication of routine medical procedures. We present two cases of CAE. The first patient was a 55-year-old male presenting with vomiting and loss of consciousness one day after his hemodialysis session. Physical exam was significant for hypotension and hypoxia with no focal neurologic deficits. Computed tomography (CT) scan of head showed gas in cerebral venous circulation. The patient did not undergo any procedures prior to presentation, and his last hemodialysis session was uneventful. Retrograde rise of venous air to the cerebral circulation was the likely mechanism for venous CAE. The second patient was a 46-year-old female presenting with fever, shortness of breath, and hematemesis. She was febrile, tachypneic, and tachycardic and required intubation and mechanical ventilation. An orogastric tube inserted drained 2500 mL of bright red blood. Flexible laryngoscopy and esophagogastroduodenoscopy were performed. She also underwent central venous catheter placement. CT scan of head performed the next day due to absent brain stem reflexes revealed intravascular air within cerebral arteries. A transthoracic echocardiogram with bubble study ruled out patent foramen ovale. The patient had a paradoxical CAE in the absence of a patent foramen ovale.

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A Case Report of Cerebral Air Embolism after Esophagogastroduodenoscopy: Diagnosis and Management in the Emergency Department

Cited by 17 publications

References 26 publications

The use of carbon dioxide in gastrointestinal endoscopy

The use of carbon dioxide in gastrointestinal endoscopy

Cerebral air embolism via port catheter and endoscopic retrograde cholangio-pancreatography

Fatal Cerebral Air Embolism: A Case Series and Literature Review

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