Soonchunhyang Med Sci.  2015 Dec;21(2):121-125. 10.0000/sms.2015.21.2.121.

A Delayed Fatal Septic Cerebral Infarction after Endoscopic Retrograde Cholangiopancreatography

• Lee SH
• Park PK
• Lee KY
• Chung WC
• Hong SG

• KMID: 2317771
• DOI: http://doi.org/10.0000/sms.2015.21.2.121

Abstract

Endoscopic retrograde cholangiopancreatography (ERCP)-related complications should be promptly and properly managed in accordance with the type and severity of the complication and the comorbidity of the patient. Neurologic complications occur very rarely, but despite of the prompt management, the patient status can severely deteriorate and sometimes result in fatality. A female patient visited SAM Medical Center for abdominal pain and yellow skin. She has taken a current medication for essential hypertension since 10 years ago. Initial laboratory findings showed obstructive jaundice and abdominal computed tomography (CT) showed two common bile duct stones with moderate dilation of bile duct. Her vital sign with oxygen saturation was stable until the first attack of seizure 12 hours later after removal of stones through the ERCP. Emergent brain CT and magnetic resonance imaging revealed multiple cerebral infarctions of both hemispheres with right predominance of middle cerebral artery territory and no evidence of air emboli. She died four days later despite of intensive care including high oxygen therapy and intravenous broad spectrum antibiotics with antiplatelet drug. We report a rare, delayed occurrence of a fatal multiple cerebral infarctions 12 hours after ERCP.

Keyword

Cerebral infarction; Fatal; Complication; Endoscopic retrograde cholangiopancreatography

MeSH Terms

Abdominal Pain
Anti-Bacterial Agents
Bile Ducts
Brain
Cerebral Infarction*
Cholangiopancreatography, Endoscopic Retrograde*
Common Bile Duct
Comorbidity
Female
Humans
Hypertension
Critical Care
Jaundice, Obstructive
Magnetic Resonance Imaging
Middle Cerebral Artery
Oxygen
Seizures
Skin
Vital Signs
Anti-Bacterial Agents
Oxygen