Venous gas embolism during endoscopy

Abstract

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.

Fatal central venous air embolism: A rare complication of esophageal dilation by rendezvous

“…20,21 Although GIE is common, venous air embolism is exceptionally rare. Venous air embolism occurs in fewer than 1 in 7500 laparoscopic cases, 19 and its documented occurrence during GIE is limited to case reports.…”

“…25 Venous pathology such as gastrointestinal varicosities may also increase risk, 20 and direct apposition of the bowel to a large or aberrant vasculature, such as exists after hepaticojejunostomy or Kasai procedure (Roux-en-Y or hepatoportojejunostomy). 20 Gas insufflated into a blind intestinal limb in these patients is hypothesized to increase risk for venous air embolism. 20 In this case, the presence of occult recurrent papillary thyroid cancer with invasion into the esophagus may have disrupted mucosal barriers in the esophagus and hypopharynx.…”

“…Continuous addition of insufflated air is hypothesized to create conditions favorable for venous air embolism by increasing intraluminal pressure. 20,22,24 Interestingly, the use of specific gas types during endoscopy or laparoscopy has been the subject of debate. 22 Currently, almost all laparoscopy is performed using carbon dioxide due to its properties as a noncombustible, commonly available gas with high aqueous solubility.…”

“…20 Interruption of mucosal barriers may be present due to ulcer, inflammatory bowel disease, vasculoenteric fistula, or instrumentation occurring as part of the endoscopic procedure itself. 25 Venous pathology such as gastrointestinal varicosities may also increase risk, 20 and direct apposition of the bowel to a large or aberrant vasculature, such as exists after hepaticojejunostomy or Kasai procedure (Roux-en-Y or hepatoportojejunostomy). 20 Gas insufflated into a blind intestinal limb in these patients is hypothesized to increase risk for venous air embolism.…”

“…20 Gas insufflated into a blind intestinal limb in these patients is hypothesized to increase risk for venous air embolism. 20 In this case, the presence of occult recurrent papillary thyroid cancer with invasion into the esophagus may have disrupted mucosal barriers in the esophagus and hypopharynx. Defects in the mucosal barrier by recurrent papillary thyroid carcinoma may have provided a portal of entry for pressurized air to escape into the vasculature.…”