Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 7, 2022; 10(1): 371-380
Published online Jan 7, 2022. doi: 10.12998/wjcc.v10.i1.371
Suspected cerebrovascular air embolism during endoscopic esophageal varices ligation under sedation with fatal outcome: A case report
Cuo-Mao-Ji Zhang, Xiao Wang
Cuo-Mao-Ji Zhang, Xiao Wang, Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Zhang CMJ collected the medical records of the patient; Zhang CMJ took responsibility for investigation and data curation; Zhang CMJ and Wang X drafted and revised the manuscript; all authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All authors declare that they have no conflicts of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xiao Wang, MD, Director, Doctor, Professor, Department of Anesthesiology, West China Hospital of Sichuan University, No. 37 Guoxue Street, Wuhou District, Chengdu 610041, Sichuan Province, China. 5681278@qq.com
Received: August 12, 2021
Peer-review started: August 12, 2021
First decision: November 11, 2021
Revised: November 19, 2021
Accepted: November 30, 2021
Article in press: November 30, 2021
Published online: January 7, 2022
Processing time: 139 Days and 17.4 Hours
Abstract
BACKGROUND

Air embolism is a very rare, yet serious and potentially fatal complication of digestive endoscopic treatment. Air embolism is the result of air directly entering the arteries or veins. However, to recognize neurological dysfunction under sedation can be difficult. Therefore, it is extremely important to identify high-risk groups and take preventive measures.

CASE SUMMARY

Herein, we report a 74-year-old female patient with esophageal varices who suffered from consciousness disturbance after the third endoscopic ligation of esophageal varices under sedation. Combined with the patient’s imaging examination results and medical history, we highly suspected that the patient had developed paradoxical cerebral air embolism during endoscopic ligation. We learned that the patient died at a later follow-up. In order to be able to identify and prevent the occurrence of air embolism early, we summarize and analyze the risk factors, pathogenesis, clinical manifestations, prevention and treatment options of gastrointestinal endoscopy complicated by cerebral air embolism.

CONCLUSION

Electroencephalographic monitoring helps to recognize the occurrence of air embolism in time and increase the patient's chance of survival.

Keywords: Cerebral infarction; Paradoxical air embolism; Endoscopic ligation; Esophageal variceal; Sedation; Case report

Core Tip: We present a rare case of suspected paradoxical cerebral air embolism during endoscopic ligation of esophageal varices. Anesthetic management and identification are challenging in patients with air embolism during digestive endoscopic treatment. We summarize and analyze the risk factors, pathogenesis, clinical manifestations, prevention and treatment options of gastrointestinal endoscopy complicated by cerebral air embolism, and propose the application of electroencephalogram monitoring during sedation or anesthesia to detect and identify abnormal brain function in time.