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Iatrogenic Complications in Five Patients with Upper Gastrointestinal Bleeding due to Ambient Air: Case Series and Literature Review.

Manser CN, Bauerfeind P, Gubler C - Case Rep Gastroenterol (2012)

Bottom Line: Two rumenocenteses and consecutively three laparotomies had to be performed in three patients.In the other two, gastroscopies had to be stopped for an emergency computed tomography.All critical incidents were believed to be a consequence of a long-lasting examination with use of too much air.

View Article: PubMed Central - PubMed

Affiliation: Clinic of Gastroenterology and Hepatology, Department of Internal Medicine, University Hospital, Zurich, Switzerland.

ABSTRACT
Despite the increasing use of carbon dioxide for endoscopies during the last years, ambient air is still used. The amount of air depends on several factors such as examination time, presumable diameter of the endoscope channel and of course active use of air by the operator. Although endoscopic complications due to ambient air in the gastrointestinal (GI) tract are a rare observation and mostly described in the colon, we report five cases in the upper GI tract due to insufflating large amounts of air through the endoscopes. All 5 patients needed an emergency upper endoscopy for acute presumed upper GI bleeding. In two cases both esophageal variceal bleeding and ulcer bleeding were detected; the fifth case presented with a bleeding due to gastric cancer. Due to insufflation of inadequate amounts of air through the endoscope channel, all patients deteriorated in circulation and ventilation. Two rumenocenteses and consecutively three laparotomies had to be performed in three patients. In the other two, gastroscopies had to be stopped for an emergency computed tomography. All critical incidents were believed to be a consequence of a long-lasting examination with use of too much air. Therefore in emergency situations, endoscopies should be performed with either submersion, low air flow pumps or even better by the use of carbon dioxide.

No MeSH data available.


Related in: MedlinePlus

CT scan of patient 2 shows distension of the stomach and small bowel (immediately after endoscopy).
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Figure 2: CT scan of patient 2 shows distension of the stomach and small bowel (immediately after endoscopy).

Mentions: Initially the 83-year-old patient had been transferred to a peripheral hospital, but due to hemodynamic instability he was transferred to our center. He had been diagnosed with carcinoma of the stomach 1 week before and presented with acute onset of hematemesis and a decline of the hemoglobin value from 9.5 to 6.7 g/dl within a week. After arrival at our center the hemoglobin had risen to 8.9 g/dl due to the application of two erythrocyte concentrates. After tracheal intubation a gastroscopy was started. Due to large amounts of blood it was switched to the large channel endoscope (6 mm diameter). After 5 min the patient developed massive abdominal distension with increasing difficulties of mechanical ventilation. A perforation was presumed. CT scan showed massive distension of the stomach and small bowel without perforation (fig. 2). Repeated endoscopy showed an ongoing bleeding near the cardia which could not be stopped; besides the patient developed an abdominal compartment syndrome with a bladder pressure of 37 mm Hg. Therefore an emergency laparotomy was performed. At that point the patient required 50–60 μg/kg/min of norepinephrine. The tumor affected not only the stomach but had also infiltrated the pancreas and colon as well as eroded the splenic artery. Due to the only marginal survival chance in case of an extensive surgery and a controlled bleeding at that time, the operation was finished after exploration. Postoperatively the patient remained circulatorily and hemostatically instable, leading to death within hours.


Iatrogenic Complications in Five Patients with Upper Gastrointestinal Bleeding due to Ambient Air: Case Series and Literature Review.

Manser CN, Bauerfeind P, Gubler C - Case Rep Gastroenterol (2012)

CT scan of patient 2 shows distension of the stomach and small bowel (immediately after endoscopy).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3362206&req=5

Figure 2: CT scan of patient 2 shows distension of the stomach and small bowel (immediately after endoscopy).
Mentions: Initially the 83-year-old patient had been transferred to a peripheral hospital, but due to hemodynamic instability he was transferred to our center. He had been diagnosed with carcinoma of the stomach 1 week before and presented with acute onset of hematemesis and a decline of the hemoglobin value from 9.5 to 6.7 g/dl within a week. After arrival at our center the hemoglobin had risen to 8.9 g/dl due to the application of two erythrocyte concentrates. After tracheal intubation a gastroscopy was started. Due to large amounts of blood it was switched to the large channel endoscope (6 mm diameter). After 5 min the patient developed massive abdominal distension with increasing difficulties of mechanical ventilation. A perforation was presumed. CT scan showed massive distension of the stomach and small bowel without perforation (fig. 2). Repeated endoscopy showed an ongoing bleeding near the cardia which could not be stopped; besides the patient developed an abdominal compartment syndrome with a bladder pressure of 37 mm Hg. Therefore an emergency laparotomy was performed. At that point the patient required 50–60 μg/kg/min of norepinephrine. The tumor affected not only the stomach but had also infiltrated the pancreas and colon as well as eroded the splenic artery. Due to the only marginal survival chance in case of an extensive surgery and a controlled bleeding at that time, the operation was finished after exploration. Postoperatively the patient remained circulatorily and hemostatically instable, leading to death within hours.

Bottom Line: Two rumenocenteses and consecutively three laparotomies had to be performed in three patients.In the other two, gastroscopies had to be stopped for an emergency computed tomography.All critical incidents were believed to be a consequence of a long-lasting examination with use of too much air.

View Article: PubMed Central - PubMed

Affiliation: Clinic of Gastroenterology and Hepatology, Department of Internal Medicine, University Hospital, Zurich, Switzerland.

ABSTRACT
Despite the increasing use of carbon dioxide for endoscopies during the last years, ambient air is still used. The amount of air depends on several factors such as examination time, presumable diameter of the endoscope channel and of course active use of air by the operator. Although endoscopic complications due to ambient air in the gastrointestinal (GI) tract are a rare observation and mostly described in the colon, we report five cases in the upper GI tract due to insufflating large amounts of air through the endoscopes. All 5 patients needed an emergency upper endoscopy for acute presumed upper GI bleeding. In two cases both esophageal variceal bleeding and ulcer bleeding were detected; the fifth case presented with a bleeding due to gastric cancer. Due to insufflation of inadequate amounts of air through the endoscope channel, all patients deteriorated in circulation and ventilation. Two rumenocenteses and consecutively three laparotomies had to be performed in three patients. In the other two, gastroscopies had to be stopped for an emergency computed tomography. All critical incidents were believed to be a consequence of a long-lasting examination with use of too much air. Therefore in emergency situations, endoscopies should be performed with either submersion, low air flow pumps or even better by the use of carbon dioxide.

No MeSH data available.


Related in: MedlinePlus