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Successful Nonsurgical Treatment of Pneumomediastinum, Pneumothorax, Pneumoperitoneum, Pneumoretroperitoneum, and Subcutaneous Emphysema following ERCP.

Fujii L, Lau A, Fleischer DE, Harrison ME - Gastroenterol Res Pract (2010)

Bottom Line: ERCP-related perforation is uncommon, but mortality rates are high.Diagnosis requires a high clinical suspicion for early detection to allow optimal management of the perforation and a better prognosis.Treatment depends on the location and mechanism and increasingly involves nonoperative management.

View Article: PubMed Central - PubMed

Affiliation: Mayo Clinic, 13400 E Shea Blvd, Department of Internal Medicine, Phoenix, AZ 85259, USA.

ABSTRACT
Complications related to endoscopic retrograde cholangiopancreatography (ERCP) include pancreatitis, hemorrhage, cholangitis, and perforation. ERCP-related perforation is uncommon, but mortality rates are high. Diagnosis requires a high clinical suspicion for early detection to allow optimal management of the perforation and a better prognosis. Treatment depends on the location and mechanism and increasingly involves nonoperative management. We report a case of successful nonsurgical treatment of a patient with extensive air involving the peritoneum, retroperitoneum, thorax, mediastinum, and subcutaneous tissues following an ERCP perforation.

No MeSH data available.


Related in: MedlinePlus

Portable chest X-ray showing subcutaneous emphysema, pneumomediastinum, and a left pneumothorax (arrow).
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fig1: Portable chest X-ray showing subcutaneous emphysema, pneumomediastinum, and a left pneumothorax (arrow).

Mentions: Postoperatively, the patient developed dyspnea and right-sided, nonradiating chest pain. Despite normal oxygen saturation on room air, supplemental oxygen via non-rebreather face mask at 100% provided no relief of her symptoms. She denied any hematemesis, hemoptysis, cough, dysphagia, or abdominal pain. She was afebrile and mildly hypertensive, without tachycardia or tachypnea. Physical exam revealed subcutaneous emphysema of the neck, thorax, abdomen, and proximal upper and lower extremities. Her heart and lung sounds were notably decreased. She had mild abdominal distention, but no peritoneal signs. The remainder of her examination was normal. Laboratory studies, including arterial blood gas, complete blood count with differential, basic metabolic panel, and cardiac enzymes, were unrevealing. Her electrocardiogram showed normal sinus rhythm without any acute changes. Portable chest and abdominal X-rays revealed subcutaneous emphysema, pneumomediastinum, small left pneumothorax, and retroperitoneal and intraperitoneal free air (Figures 1 and 2).


Successful Nonsurgical Treatment of Pneumomediastinum, Pneumothorax, Pneumoperitoneum, Pneumoretroperitoneum, and Subcutaneous Emphysema following ERCP.

Fujii L, Lau A, Fleischer DE, Harrison ME - Gastroenterol Res Pract (2010)

Portable chest X-ray showing subcutaneous emphysema, pneumomediastinum, and a left pneumothorax (arrow).
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2901617&req=5

fig1: Portable chest X-ray showing subcutaneous emphysema, pneumomediastinum, and a left pneumothorax (arrow).
Mentions: Postoperatively, the patient developed dyspnea and right-sided, nonradiating chest pain. Despite normal oxygen saturation on room air, supplemental oxygen via non-rebreather face mask at 100% provided no relief of her symptoms. She denied any hematemesis, hemoptysis, cough, dysphagia, or abdominal pain. She was afebrile and mildly hypertensive, without tachycardia or tachypnea. Physical exam revealed subcutaneous emphysema of the neck, thorax, abdomen, and proximal upper and lower extremities. Her heart and lung sounds were notably decreased. She had mild abdominal distention, but no peritoneal signs. The remainder of her examination was normal. Laboratory studies, including arterial blood gas, complete blood count with differential, basic metabolic panel, and cardiac enzymes, were unrevealing. Her electrocardiogram showed normal sinus rhythm without any acute changes. Portable chest and abdominal X-rays revealed subcutaneous emphysema, pneumomediastinum, small left pneumothorax, and retroperitoneal and intraperitoneal free air (Figures 1 and 2).

Bottom Line: ERCP-related perforation is uncommon, but mortality rates are high.Diagnosis requires a high clinical suspicion for early detection to allow optimal management of the perforation and a better prognosis.Treatment depends on the location and mechanism and increasingly involves nonoperative management.

View Article: PubMed Central - PubMed

Affiliation: Mayo Clinic, 13400 E Shea Blvd, Department of Internal Medicine, Phoenix, AZ 85259, USA.

ABSTRACT
Complications related to endoscopic retrograde cholangiopancreatography (ERCP) include pancreatitis, hemorrhage, cholangitis, and perforation. ERCP-related perforation is uncommon, but mortality rates are high. Diagnosis requires a high clinical suspicion for early detection to allow optimal management of the perforation and a better prognosis. Treatment depends on the location and mechanism and increasingly involves nonoperative management. We report a case of successful nonsurgical treatment of a patient with extensive air involving the peritoneum, retroperitoneum, thorax, mediastinum, and subcutaneous tissues following an ERCP perforation.

No MeSH data available.


Related in: MedlinePlus