Bilateral Pneumothorax and Subcutaneous Emphysema following Endoscopic Retrograde Cholangiopancreatography: A Rare Complication

Sampaziotis, Fotios; Wiles, A; Shaukat, Syed Shahid; Dickinson, Rebecca

doi:10.1155/2010/894045

Cited by 8 publications

(9 citation statements)

References 16 publications

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“…During ERCP, air can reach pleural cavity through duodenal rupture porous diaphragm syndrome [9] or alveolar rupture. In most cases, pneumothorax coexists with pneumoretroperitoneum.…”

Section: Discussionmentioning

confidence: 99%

Fatal Pneumothorax Secondary to Duodenal Perforation After Endoscopic Retrograde Cholangiopancreatography

Rana¹

2014

J Med Cases

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Endoscopic retrograde cholangiopancreatography (ERCP) is a widely accepted diagnostic and therapeutic modality for extrahepatic biliary and pancreatic pathologies. Although minimally invasive and day case procedure, it is not free from complications including bleeding, perforation, cholangitis and pancreatitis. Some of these complications, if left undiagnosed or poorly managed can become life threatening such as pneumothorax secondary to duodenal perforation. Hence, recognition and understanding of potential complications of ERCP is vital. We report a case of rapidly fatal duodenal perforation with pneumoperitoneum, pneumoretroperitoneum, bilateral pneumothoraces, pneumomediastinum, and subcutaneous emphysema causing hemodynamic compromise.

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“…During ERCP, air can reach pleural cavity through duodenal rupture porous diaphragm syndrome [9] or alveolar rupture. In most cases, pneumothorax coexists with pneumoretroperitoneum.…”

Section: Discussionmentioning

confidence: 99%

Fatal Pneumothorax Secondary to Duodenal Perforation After Endoscopic Retrograde Cholangiopancreatography

Rana¹

2014

J Med Cases

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“…Pneumothorax is usually right‐sided (55%) or bilateral (40%) and accompanied by pneumomediastinum, pneumoperitoneum, and subcutaneous emphysema . The pathophysiology is air leakage causing a pneumoretroperitoneum (with or without obvious duodenal perforation), especially pre‐cut sphincterotomy, followed by the development of pneumomediastinum and pneumothorax . Tension pneumothorax has been reported .…”

Section: Pneumothorax Pneumoperitoneum and Subcutaneous Emphysemamentioning

confidence: 99%

“…57 The pathophysiology is air leakage causing a pneumoretroperitoneum (with or without obvious duodenal perforation), especially pre-cut sphincterotomy, followed by the development of pneumomediastinum and pneumothorax. 58,59 Tension pneumothorax has been reported. 60,61 Most cases are successfully treated conservatively with antibiotics, fasting, and chest tube drainage when indicated.…”

Section: Pneumothorax Pneumoperitoneum and Subcutaneous Emphysemamentioning

confidence: 99%

Uncommon and rarely reported adverse events of endoscopic retrograde cholangiopancreatography

Chavalitdhamrong

Donepudi

et al. 2013

Digestive Endoscopy

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Endoscopic retrograde cholangiopancreatography (ERCP) has become a primary tool for the treatment of biliary and pancreatic ductal diseases. It is essential for the endoscopist carrying out the ERCP to have a thorough understanding of the potential adverse events. Typically, endoscopists are well familiar with common adverse events such as post-ERCP pancreatitis, cholangitis, post-sphincterotomy bleeding, post-sphincterotomy perforation, and sedation-related cardiopulmonary compromises. However, there are other less common adverse events that are critical to promptly recognize in order to provide appropriate therapy and prevent disastrous outcomes. This review focuses on the presentation and management of the less common and rare adverse events of an ERCP from the perspective of the practicing endoscopist.

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“…Complications of ERCP include postinterventional pancreatitis, haemorrhage, cholangitis and perforation. However, bilateral pneumothraces, pneumomediastinum and subcutaneous emphysema after ERCP are very rare in the literature and till now there have been only four cases reported 2 3…”

Section: Descriptionmentioning

confidence: 99%

Bilateral pneumothoraces, pneumomediastinum and subcutaneous emphysema as a rare complication of endoscopic cholangiopancreatography

2012

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DESCRIPTIONA 67-year-old woman underwent endoscopic cholangiopancreatography (ERCP) for elective exchange of a bile duct stent. The ductus hepaticus communis was stented because of a bilary stricture of unknown aetiology for the first time half a year ago. Multiple previous performed ERCPs were without any complications and show no unexpected findings. The previously placed stent was extracted and replaced by a new 10 French stent. The patient remained stable through the intervention with close monitoring and there were no complications. Immediately after the intervention, the patient developed a progressive dyspnoea. She was tachypnoeic and physical examination revealed subcutaneous emphysema of the thorax and the neck (figure 1). Heart and lung sounds were noticeably decreased. A CT with oral contrast indicated a perforation of the oesophagus as the cause of bilateral pneumothoraces, pneumomediastinum and subcutaneous emhysema (figure 2). The patient was admitted to the intensive care unit where a chest tube was placed and an endoscopic re-evaluation was performed. Intraluminal, there was no hint for perforation. Under non-surgical management, bilateral pneumothoraces, pneumomediastinum and subcutaneous emhysema were regredient and the patient was discharged asymptomatic after 9 days. ERCP is a widely used diagnostic and therapeutic tool in gastrointestinal daily practice. Most complications are rare with a complication rate of 4-10% and a mortality of 0.4%.1 Complications of ERCP include postinterventional pancreatitis, haemorrhage, cholangitis and perforation. However, bilateral pneumothraces, pneumomediastinum and subcutaneous emphysema after ERCP are very rare in the literature and till now there have been only four cases reported.

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Bilateral Pneumothorax and Subcutaneous Emphysema following Endoscopic Retrograde Cholangiopancreatography: A Rare Complication

Cited by 8 publications

References 16 publications

Fatal Pneumothorax Secondary to Duodenal Perforation After Endoscopic Retrograde Cholangiopancreatography

Fatal Pneumothorax Secondary to Duodenal Perforation After Endoscopic Retrograde Cholangiopancreatography

Uncommon and rarely reported adverse events of endoscopic retrograde cholangiopancreatography

Bilateral pneumothoraces, pneumomediastinum and subcutaneous emphysema as a rare complication of endoscopic cholangiopancreatography

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