Fatal air embolism resulting from gastroscopy

Katzgraber, F.; Glenewinkel, F.; Rittner, Christian; Beule, Johannes

doi:10.1016/s0140-6736(95)92885-5

Cited by 19 publications

(13 citation statements)

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“…The detection of gases of putrefaction alone does not exclude an air embolism. Final evaluation will always have to consider other evidence (typical previous history, typical circumstances of dying [2,[13][14][15][16][17], detection of entrance sites, absence of other causes of death, histological findings [18][19][20], "matching" confession of a suspect).…”

Section: Discussionmentioning

confidence: 99%

Proof of air embolism after exhumation

Bajanowski

Köhler

DuChesne

et al. 1998

International Journal of Legal Medicine

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The detection, storage, and analysis of gas taken from the heart ventricle is necessary to diagnose a fatal air embolism and this requires special precautions during autopsy. When the results of gas analysis correspond to the criteria defined by Pierucci and Gherson the diagnosis "air embolism" is justified. In cases showing putrefaction the diagnostic value of gas analysis was negated. In a series of 15 patients who were assumed to have been killed by air injection in a peripheral vein the corpses were exhumed and a full medico-legal examination was carried out including gas analysis. In 8 cases results could be obtained indicating a mixture of embolised air and gases of putrefaction. In two control groups comprising 10 exhumed bodies and 30 cases showing advanced putrefaction, gas analysis showed putrefaction gases except in 5 cases with gas volumes less than 5 ml in the right ventricle. Therefore gas analysis can be helpful to diagnose fatal air embolism even in cases showing putrefaction while the diagnosis of putrefaction gases only does not exclude this diagnosis.

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Section: Discussionmentioning

confidence: 99%

Proof of air embolism after exhumation

Bajanowski

Köhler

DuChesne

et al. 1998

International Journal of Legal Medicine

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“…This is also necessary in cases of barotrauma [7]. Circumstances indicating a possible air embolism include injuries to the great veins of the upper extremities and the neck, pneumothorax, basal skull fractures, sudden death during surgical or therapeutic intervention (infusion, transfusion [10], endoscopy [11,12]), during birth [13], criminal abortion [14], injection marks of unclear origin, e.g. in drug abuse; also after resuscitation attempts, in cases with unclear previous history, and tissue emphysema or tissue swelling [7].…”

Section: External Inspectionmentioning

confidence: 99%

Proof of fatal air embolism

Bajanowski¹,

West²,

Brinkmann³

1998

International Journal of Legal Medicine

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Venous air embolism is a rare cause of death. Entry of gas into the circulation is caused by trauma, mostly surgical or therapeutic, and sometimes resulting from criminal intervention. The detection of air embolisms requires special precautions during autopsy. An aspirometer has to be used for the detection, measurement and storage of gas originating from the heart ventricles. The aspirometer has to be filled completely with distilled water containing two drops of Tween 80 to reduce the surface tension of the water and to prevent adherence of small air bubbles to the wall of the aspirometer. Subsequently the gas has to be analysed by gas chromatography. When the results correspond with the main criteria defined by Pierucci and Gherson [2] the diagnosis "air embolism" is justified. The technique for the detection of air embolism is simple but requires a careful procedure which is described in detail.

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“…Patient 5 suffered a cerebral gas embolism due to the presence of a duodenocaval fistula [5]. Finally, patient 7, a 56-year-old man who died during a routine gastroscopy was found on postmortem examination to have a large gastric ulcer with an open vessel at its base [14].…”

Section: Discussionmentioning

confidence: 99%

“…A slow, continuous infusion of gas (0.3 ml/kg/min) into venous circulation may be absorbed across the pulmonary capillary bed without significant clinical impact. At higher infusion rates, bubbles in pulmonary arterioles can trigger cytokine release and neutrophil activation, with subsequent pulmonary vasocon- [16] 1988 4 mo F Endoscopy of Kasai limb VGE, death Kasai procedure 3 [21] 1988 23 yr F ERCP, sphincterotomy Portal venous gas Sphincterotomy 4 [8] 1990 10 yr F Endoscopy of Kasai limb VGE, death Kasai procedure, varices 5 [5] 1994 66 yr F EGD Cerebral gas embolus, death Duodenocaval fistula 6 [2] 1994 31 yr M ERCP, sphincterotomy Portal venous gas Sphincterotomy 7 [14] 1995 56 yr M Gastroscopy VGE, death Gastric ulcer 8 [15] 1997 63 yr F ERCP, sphincterotomy VGE, death Sphincterotomy ERCP, endoscopic retrograde cholangiopancreatography; EGD, esophagogastroduodenoscopy; VGE, venous gas embolism. striction, bronchospasm, and pulmonary edema.…”

Section: Discussionmentioning

confidence: 99%

Venous gas embolism during endoscopy

et al. 1999

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Venous gas embolism is a rare but serious complication of laparoscopic and endoscopic procedures. We describe the case of a 33-year-old woman with a strictured hepaticojejunostomy anastomosis who was treated with transabdominal endoscopic balloon dilation. During the procedure, she suffered a venous gas embolus with immediate cardiovascular collapse. After treatment with pressors, electrical cardioversion, and multiple aspirations of the right ventricle, the patient recovered fully. We reviewed all reported cases of venous gas embolism during endoscopy over the past 30 years and identified multiple risk factors. We suggest precautions to minimize future complications in patients at increased risk.

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Fatal air embolism resulting from gastroscopy

Cited by 19 publications

References 0 publications

Proof of air embolism after exhumation

Proof of air embolism after exhumation

Proof of fatal air embolism

Venous gas embolism during endoscopy

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