Fatal hepatic air embolism following ERCP

Myocardial and cerebral infarction due to massive air embolism following endoscopic retrograde cholangiopancreatography (ERCP)

“…The troponin level at 12 hours post event was significantly elevated at 0.85 ng/mL. Systemic air embolism following ERCP has only been described on four previous occasions [1 -4], although reports on venous air embolism are more abundant [5]. The present case is novel in that myocardial infarction due to air embolism after ERCP has not previously been reported.…”

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

“…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.…”

Systemic air embolism after ERCP: a case report and review of the literature (with video)

“…[1][2][3][4][5][6][7] The precise mechanism of this complication is unknown and likely varies depending on the case (Table 1). Air can pass directly into the hepatic veins 3 or traverse the portal circulation.…”