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This case report details a rare survivor of paradoxical gas embolism during endoscopic retrograde cholangiopancreatography (ERCP). Prompt resuscitation and interventions led to the patient

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Area of Science:

  • Gastroenterology
  • Cardiology
  • Critical Care Medicine

Background:

  • Gas embolism is a rare but potentially fatal complication of Endoscopic retrograde cholangiopancreatography (ERCP).
  • Paradoxical gas embolism occurs when gas enters the venous circulation and crosses into the arterial circulation, often through a patent foramen ovale.

Purpose of the Study:

  • To report the unique case of a patient who survived paradoxical gas embolism during ERCP.
  • To highlight the diagnostic and management strategies for this critical event.

Main Methods:

  • Case report of a patient experiencing paradoxical gas embolism during ERCP.
  • Utilized transesophageal echocardiography (TEE) for diagnosis.
  • Managed with advanced resuscitation techniques including vasopressors and high-concentration oxygen.

Main Results:

  • The patient presented with severe respiratory and circulatory collapse, including unmeasurable end-tidal carbon dioxide, hypoxemia, hypotension, and bradycardia.
  • Transesophageal echocardiography confirmed massive biventricular gas bubbles and a patent foramen ovale.
  • Successful resuscitation resulted in the disappearance of gas bubbles and full recovery without neurological deficits.

Conclusions:

  • Paradoxical gas embolism during ERCP, though rare, is a life-threatening emergency.
  • Prompt recognition, advanced hemodynamic support, and echocardiographic monitoring are crucial for survival.
  • Maintaining vigilance for gas embolism during endoscopic procedures is essential for patient safety.