Air embolism after biliary stent removal during endoscopic retrograde cholangiopancreatography for cholangitis after biliary reconstruction: a case report

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  • TAKAHASHI Kosuke
    Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences
  • OZAWA Eisuke
    Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences
  • TAJIMA Kazuaki
    Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences
  • FUKUSHIMA Masanori
    Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences
  • IMAMURA Ippo
    Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences
  • MATSUSHIMA Hajime
    Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences
  • ADACHI Tomohiko
    Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences
  • HAYASHI Yoko
    Department of Pathology, Nagasaki University School of Medicine and Graduate School of Biomedical Sciences
  • EGUCHI Susumu
    Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences
  • NAKAO Kazuhiko
    Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences

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  • 胆道再建後の胆管炎に対して胆管ステント抜去後に空気塞栓症を発症した1例

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Abstract

<p>A 62-year-old male patient underwent pancreaticoduodenectomy with modified Child reconstruction for distal cholangiocarcinoma. After eight years, a contrast-enhanced computed tomography (CT) revealed a recurrent lesion at the biliojejunal anastomosis, and a biliary stent was placed for obstructive cholangitis in the right posterior segment of the liver. A right hepatectomy was planned for a local recurrent lesion;thus, percutaneous transhepatic portal embolization was performed on the portal vein's right branch to enlarge the left liver. However, he was referred to our department for endoscopic retrograde biliary drainage for the subsequent cholangitis and liver abscess appearance. A double-balloon enteroscope under CO2 insufflation was used to reach the bile duct-jejunal anastomosis. After removing the bile duct stent with grasping forceps, his general condition suddenly deteriorated, causing cardiopulmonary arrest. He was diagnosed with air embolism based on the findings of air in the heart, aorta, and brain on CT after the return of spontaneous circulation. Treatment for the air embolism and subsequent complications continued in the intensive care unit, but he eventually died 114 days after the onset of the air embolism due to his deteriorating general condition. Pathological autopsy revealed cholangiocarcinoma that extends from the porta hepatis to the posterior segment. Additionally, the proximity between the bile duct and vein extended by the adenocarcinoma and the fibrous obstruction of the vein were revealed, indicating the possibility of a bile duct-vein shunt.</p>

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