Gas Embolism Complicating Endoscopic Retrograde Cholangiopancreaticography: Case Report of a Complex Condition

This case report explores the complex clinical trajectory of a 72-year-old female with a history of hypertension, iron-deficiency anaemia, and vertigo, who underwent an endoscopic retrograde cholangiopancreaticography (ERCP) procedure for common bile duct (CBD) stone removal. After an uneventful laparoscopic cholecystectomy, she continued to experience abdominal pain and icterus. Investigations including magnetic resonance cholangiopancreatography (MRCP), revealed a dilated CBD with multiple stones, prompting ERCP. During the procedure, a fall in saturation and arrhythmia were noted, leading to the diagnosis of gas embolism. Trans-esophageal echocardiography (TEE) confirmed air bubbles in cardiac chambers and a patent foramen ovale (PFO). Despite interventions, including intubation, noradrenaline infusion, and a temporary pacemaker, the patient's cardiovascular status deteriorated. Due to financial constraints, she was discharged against medical advice (DAMA) with a high-risk profile. This case highlights the rarity and iatrogenic nature of ERCP-related air embolism, emphasising the challenges in its management and underscoring the need for awareness and timely intervention. The discussion delves into the broader context of air embolism pathogenesis, referencing relevant literature and highlighting the need for continued research in managing such rare complications associated with ERCP.