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ERCP sonrası gelişen bilateral pnömotoraks, pnömomediasten, pnömoretroperituan ve cilt altı amfizemi

Year 2017, Volume: 9 Issue: 2, 28 - 30, 01.08.2017

Abstract

Giriş: Pnömotoraks plevra yaprakları arasına hava toplanmasıdır. ERCP komlikasyonu olarak bilateral pnömotoraks, pnömomediasten, pnömoretroperituan ve cilt altı amfizemi gelşimi oldukça nadirdir. Metod: Yetmişbir yaşında kadın hasta; kolelithiazis nedeniyle ERCP uygulanırken ani solunum sıkıntısı ve sol yan ağrısı gelişmesi üzerine işleme son verilmiş. Belirgin dispnesi olan hastanın muayenesinde yüz, boyun ve göğüs bölgesinde cilt altı amfizemine bağlı çıtırtı sesi saptandı. Bilateral solunum sesleri azalmış ve batında distansiyon mevcuttu. Acil olarak çekilen toraks bilgisayarlı tomografisinde bilateral pnömotoraks saptanması üzerine hasta yoğun bakım ünitesinde takibe alınarak bilateral toraks tüpü ve nazogastrik sonda takıldı. Geniş spektrumlu antibiyotik ve sürekli nazal oksijen tedavisi başlandı. Ösofagogastrografide; ösofagusta perforasyon saptanmadı. Solunum sıkıntısı gerileyen hastanın toraks tüpleri dördüncü günde çekildi. Hasta serviste takibe alındı ve yatışının 14. gününde sorunsuz olarak taburcu edildi. Tartışma: Pnömotoraks, endoskopik retrograd kolanjiyo-pankreatografi işleminin çok nadir bir komplikasyonudur. Semptomlar hastanın yaşı, bazal solunum fonksiyonları, pnömotoraksın derecesine göre değişebilir. Hafif olgularda konservatif tedavi tercih edilirken, ağır olgularda toraks tüpü takılması ve veya perfore duodenumun cerrahi olarak onarılması gerekebilir. Sonuç: Sunulan nadir komplikasyonda tipik fizik muayene ve radyolojik bulgular ile tanı konulabilir Hastanın klinik durumuna göre tedavi yaklaşımı belirlenir. Toraks tüpü takılması pnömotoraksın tedavisinde etkili olduğu gibi ciltaltı amfizeminin de düzelmesini sağlar.

References

  • 1. Berger R. Iatrogenic pneumothorax. Chest 1994; 105: 980-981.
  • 2. Ferrara F, Luigiano C, Billi P, Jovine E, Cinquantini F, D’Imperio N. Pneumothorax, pneumomediastinum, pneumoperitoneum, pneumoretroperitoneum and subcutaneous emphysema after ERCP. Gastrointest Endosc. 2009; 69: 1398-401.
  • 3. Sampaziotis F, Wiles A, Shaukat S, Dickinson RJ. Bilateral pneumothorax and subcutaneous emphysema following Endoscopic Retrograde Cholangiopancreatography: A rare complication. Diagn Ther Endosc. 2010; 2010. pii: 894045.
  • 4. Loperfido S, Angelini G, Benedetti G,et.al Major early complications from diagnostic and therapeutic ERCP: a prospective multicenter study. Gastrointestinal endoscopy 1998;48,1:1-10.
  • 5. Andriulli A, Loperfido S, Napolitano G, et.al Incidence rates of Post-ERCP complications: A systematic survey of prospective studies. The American Journal of gastroenterology 2007; 102: 1781-1788.
  • 6. Al-Ashaal YI, Hefny AF, Safi F, Abu-Zidan FM. Tension pneumothorax complicating Endoscopic Retrograde Cholangiopancreatography: case report and systematic literature rewiev. Asian J Surg. 2011; 34: 46-9.
  • 7. Neofytou K, Petrou A, Savva C, et.al Pneumothorax following ERCP: Report of two cases with different pathophsiology. Case Rep Med. 2013;2013: 206564.
  • 8. Fujii L, Lau A, Fleischer DE, Harrison ME. Successful nonsurgical treatment of pneumomediastinum, pneumothorax, pneumoperitoneum, pneumoretroperitoneum and subcutaneous emphysema following ERCP. Gastroenterol Res Pract. 2010; 2010: 289135.
  • 9. espars JA, Sassoon CS, Light RW. Significance of iatrogenic pneumothoraces. Chest. 1994; 105: 1147-1450.
  • 10. Yılmaz A, Bayramgürler B, Yazıcıoğlu Ö, Ünver E. Iatrogenic pneumothorax: incidence and evaluation of the therapy. Turkish Respiratory Journal 2002; 3: 64-67.

Bilateral pneumothorax, pneumomediastinum, pneumoretroperitoneum and subcutaneous emphysema following ERCP

Year 2017, Volume: 9 Issue: 2, 28 - 30, 01.08.2017

Abstract

Introduction: Pneumothorax is defined as presence of air in the potential space between parietal and visceral pleura. Bilateral pnömotoraks with pneumomediastinum, pneumoretroperitoneum and subcutaneous emphysema is quite a rare complication of ERCP Method: We present a case of a 71-year-old woman with known cholelithiasis who underwent ERCP for diagnostic purposes. During the procedure she developed sudden onset respiratory distress and severe left sided back pain so the procedure was discontinued. Physical examination revealed crackles on the skin of face, neck and chest suggesting subcutaneous emphysema, bilaterally diminished breath sounds and abdominal distension. Thorax computerised tomography scan at emergency department revealed bilateral pneumothorax. The patient was managed with immediate bilateral chest tube placement, nasogastric suction and broad spectrum antibiotics. There was no sign of esophageal perforation on esophagography. The chest tubes were removed on the fourth day without any problem and the patient was discharged on the 14 th day. Discussion: Pneumothorax is a very rare complication of endoscopic retrograde cholangio-pancreatography. Symptoms may vary according to age, respiratory capacity of the patient and degree of pneumothorax. Mild cases may be treated conservatively while tube drainage for px and surgical repair of duodenal perforation is necessary for more severe cases. Conclusion: This rare condition can be recognised with typical physical and radiographic findings. General condition of the patient is the main criterion for selection of treatment modality. Tube drainage is effective for treatment of pneumothorax, it also improves the subcutaneous emphysema.

References

  • 1. Berger R. Iatrogenic pneumothorax. Chest 1994; 105: 980-981.
  • 2. Ferrara F, Luigiano C, Billi P, Jovine E, Cinquantini F, D’Imperio N. Pneumothorax, pneumomediastinum, pneumoperitoneum, pneumoretroperitoneum and subcutaneous emphysema after ERCP. Gastrointest Endosc. 2009; 69: 1398-401.
  • 3. Sampaziotis F, Wiles A, Shaukat S, Dickinson RJ. Bilateral pneumothorax and subcutaneous emphysema following Endoscopic Retrograde Cholangiopancreatography: A rare complication. Diagn Ther Endosc. 2010; 2010. pii: 894045.
  • 4. Loperfido S, Angelini G, Benedetti G,et.al Major early complications from diagnostic and therapeutic ERCP: a prospective multicenter study. Gastrointestinal endoscopy 1998;48,1:1-10.
  • 5. Andriulli A, Loperfido S, Napolitano G, et.al Incidence rates of Post-ERCP complications: A systematic survey of prospective studies. The American Journal of gastroenterology 2007; 102: 1781-1788.
  • 6. Al-Ashaal YI, Hefny AF, Safi F, Abu-Zidan FM. Tension pneumothorax complicating Endoscopic Retrograde Cholangiopancreatography: case report and systematic literature rewiev. Asian J Surg. 2011; 34: 46-9.
  • 7. Neofytou K, Petrou A, Savva C, et.al Pneumothorax following ERCP: Report of two cases with different pathophsiology. Case Rep Med. 2013;2013: 206564.
  • 8. Fujii L, Lau A, Fleischer DE, Harrison ME. Successful nonsurgical treatment of pneumomediastinum, pneumothorax, pneumoperitoneum, pneumoretroperitoneum and subcutaneous emphysema following ERCP. Gastroenterol Res Pract. 2010; 2010: 289135.
  • 9. espars JA, Sassoon CS, Light RW. Significance of iatrogenic pneumothoraces. Chest. 1994; 105: 1147-1450.
  • 10. Yılmaz A, Bayramgürler B, Yazıcıoğlu Ö, Ünver E. Iatrogenic pneumothorax: incidence and evaluation of the therapy. Turkish Respiratory Journal 2002; 3: 64-67.
There are 10 citations in total.

Details

Primary Language Turkish
Subjects Clinical Sciences
Journal Section Case Report
Authors

Bengü Şaylan This is me

Şeyma Başlılar This is me

Gülay Oludağ This is me

Sedef Kaya This is me

Nesrin Sarıman This is me

Publication Date August 1, 2017
Submission Date May 12, 2014
Published in Issue Year 2017 Volume: 9 Issue: 2

Cite

Vancouver Şaylan B, Başlılar Ş, Oludağ G, Kaya S, Sarıman N. ERCP sonrası gelişen bilateral pnömotoraks, pnömomediasten, pnömoretroperituan ve cilt altı amfizemi. Maltepe tıp derg. 2017;9(2):28-30.