J Korean Med Sci.  2009 Feb;24(1):173-175. 10.3346/jkms.2009.24.1.173.

Tension Pneumothorax after Endoscopic Retrograde Pancreatocholangiogram

• Song SY
• Lee KS
• Na KJ
• Ahn BH

• KMID: 1794428
• DOI: http://doi.org/10.3346/jkms.2009.24.1.173

Abstract

We report a case of tension pneumothorax after an endoscopic sphincterotomy. A 78-yr-old woman presented with progressing dyspnea. She had undergone an endoscopic retrograde cholangiopancreatogram three days before due to acute cholecystitis. She underwent endoscopic sphincterotomy for stone extraction, but the procedure failed. On arrival to our hospital, she complained about severe dyspnea and she had subcutaneous emphysema. A computed tomogram scan revealed severe subcutaneous emphysema, right-side tension pneumothorax, and pneumoretroperitoneum. Contrast media injected through a transnasal biliary drainage catheter spilled from the second portion of the duodenum. A second abdominal computed tomogram showed multiple air densities in the retroperitoneum and peritoneal cavity, which were consistent with panperitonitis. We recommended an emergent laparotomic exploration, but the patient's guardians refused. She died eventually due to septic shock. Endoscopic retrograde cholangiopancreatogram is a popular procedure for biliary and pancreatic diseases, but it can cause severe complications such as intestinal perforation. Besides perforations, air can spread through the abdominal cavity, retroperitoneum, mediastinum, and the neck soft tissue, eventually causing pneumothorax. Early recognition and appropriate management is crucial to an optimal output of gastrointestinal perforation and pneumothorax.

Keyword

Pneumothorax; Cholangiopancreatography; Sphincterotomy; Complications

MeSH Terms

Acute Disease
Aged
Cholangiopancreatography, Endoscopic Retrograde/*adverse effects
Cholecystitis/diagnosis
Female
Humans
Intestinal Perforation/etiology
Pneumothorax/*diagnosis/etiology
Retropneumoperitoneum/*diagnosis/etiology
Sphincterotomy, Endoscopic
Tomography, X-Ray Computed

Figure

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  Fig. 1 The initial chest and abdominal computed tomograms showing severe subcutaneous emphysema, pneumothorax, pneumomediastinum, deviated mediastinum and pneumoperitoneum.

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  Fig. 2 An abdominal computed tomogram after injection of contrast media via biliary drainage catheter. The scan shows catheter and retroperitoneal dye spillage (arrow).

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