Pneumothorax Following ERCP: Report of Four Cases and Review of the Literature

Abstract

We report four patients with pneumothorax as a complication of ERCP with sphincterotomy. With conservative treatment all patients recovered. Previously, 16 comparable cases have been reported in the literature. The main risk factor for this rare complication seems (pre-cut) sphincterotomy. Pneumothorax is usually right-sided or bilateral and accompanied by pneumomediastinum, pneumoretroperitoneum and subcutaneous emphysema. The prognosis seems favourable with a non-surgical approach including intravenous antibiotics, fasting and when indicated chest tube drainage.

Post-endoscopic retrograde cholangiopancreatography pneumomediastinum caused by probing a pseudopapilla: Case report of a rare complication treated conservatively

“…Pneumothorax, pneumomediastinum and subcutaneous emphysema have also been reported in association with ERCP and sphincterotomy [2]. The constellation of pneumomediastinum with subcutaneous emphysema without pneumothorax has been described in one other case report [3], and in that report the patient was also successfully managed with conservative care.…”

Rare and underappreciated complications of endoscopic retrograde cholangiopancreatography

“…In the absence of an overt perforation, pneumothorax and pneumoperitoneum may occur following ERCP owing to leakage of air from the duodenum into the retroperitoneal space [90]. Air then migrates to the peritoneum to cause pneumoperitoneum, as well as the mediastinum (via the diaphragm) and the pleural Fig.…”

“…A loop is less likely to perforate (or even become embedded in) a pancreatic duct side branch. space, resulting in a pneumothorax [90]. Alternatively, spontaneous pneumothorax may occur owing to alveolar damage from elevated pressure in the thoracic cavity [90].…”

“…In a literature review of 20 cases, pneumothoraces after ERCP were observed in patients of all ages (24-88 years) and either involved the right pleural space or were present bilaterally [90]. When a pneumothorax is suspected after ERCP, usually only a plain chest film is necessary to confirm the diagnosis, although CT of chest and abdomen may be required to seek an alternative diagnosis or to detect any coexisting pathology if no clinical improvement is seen [90].…”

“…When a pneumothorax is suspected after ERCP, usually only a plain chest film is necessary to confirm the diagnosis, although CT of chest and abdomen may be required to seek an alternative diagnosis or to detect any coexisting pathology if no clinical improvement is seen [90]. Management is usually conservative with administration of oxygen, intravenous antibiotics, nothing by mouth, and placement of chest tubes.…”