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Death during ERCP
Discussion in 'All Categories' started by Neeraj - Oct 31st, 2012 1:10 pm.
For nearly two years I have been researching laparoscopic cholecystectomy and have discovered your website. I know that you are a teaching hospital and wonder if you could tell me about any unusual cases which may be similar to ours. I have no medical background other than what I have been able to learn online.

My sister, a 51 year old healthy woman was operated on for a laparoscopic cholecystectomy on February 18, 2011. Her husband and I were waiting at the hospital while the surgery took place. The surgeon came to us and said that there was some sludge in the common bile duct which he would be unable to remove from his surgical position. So, he wanted permission from us to have a GI doctor perform an ERCP immediately. Since she was still in the operating room, we signed off on the second procedure. The other option would have been to wait and do the ERCP at a later date.

The GI doctor performed the ERCP using a basket rather than a balloon due to my sister's latex allergy. He completed his procedure and withdrew his endoscopic equipment. Almost immediately my sister experienced what the doctors have referred to as a "catastrophic event". The total length of the event was, again according to the doctors, "twenty to thirty seconds". Air rushed into her heart and killed her. The air could not be cleared from the right side of the heart because it was "under pressure". A TEE was inserted and it showed that the inferior vena cava and the heart were swelled with "massive amounts of air". Attempts to relieve the air in the heart were futile because the air kept feeding back in. After working for an additional hour and twenty minutes and calling in multiple specialists, the doctors pronounced my sister dead.

Through all of my research which I have done online, the only theory I can come up with is that perhaps the first surgeon nicked the portal vein and then, when the GI doctor cleared the common bile duct of the sludge and removed his equipment, the common bile duct relaxed and released the pressure on the portal vein. This then allowed the nick made by the first surgeon to open and the air with which my sister had been insufflated rush through that opening, into the inferior vena cava and into the right side of the heart. Because the event was almost instantaneous, it would seem that it had to have a fairly direct route. A friend suggested that maybe the air backed up through the liver but I would suppose that to have been much slower.

Have you ever experienced similar cases in your facility? Do you have any ideas as to what may have caused this sequence of events to take place? Are you aware of case studies elsewhere which may be of value in understanding what happened to my sister and the mechanism for air under pressure to fill the heart and kill someone?

Thank you for your time and consideration. Blessings to you all on the good work which you do on behalf of humankind.
re: Death during ERCP by Dr J S Chowhan - Nov 5th, 2012 10:54 am
Dr J S Chowhan
Dr J S Chowhan
Dear Neeraj

In our opinion the death was due to air embolism. Usually, when symptoms are present, they are nonspecific, and a high index of clinical suspicion of possible venous air embolism is required to prompt investigations and initiate appropriate therapy.

pid entry or large volumes of air entering the systemic venous circulation puts a substantial strain on the right ventricle, especially if this results in a significant rise in pulmonary artery (PA) pressures. This increase in PA pressure can lead to right ventricular outflow obstruction and further compromise pulmonary venous return to the left heart.

The potentially life-threatening and catastrophic consequences of venous air embolism (VAE) are directly related to its effects on the affected organ system where the embolus lodges.

With regards

J S Chowhan
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