[abstract] CEREBRAL AIR EMBOLISM AFTER ESOPHAGOGASTRODUODENOSCOPY (EGD): UNSUCCESSFUL TREATMENT WITH HYPERBARIC OXYGENATION THERAPY.

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[abstract] CEREBRAL AIR EMBOLISM AFTER ESOPHAGOGASTRODUODENOSCOPY (EGD): UNSUCCESSFUL TREATMENT WITH HYPERBARIC OXYGENATION THERAPY.

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Title: [abstract] CEREBRAL AIR EMBOLISM AFTER ESOPHAGOGASTRODUODENOSCOPY (EGD): UNSUCCESSFUL TREATMENT WITH HYPERBARIC OXYGENATION THERAPY.
Author: Johnson-Arbor, K
Abstract: BACKGROUND: Venous air embolism is infrequently described after gastrointestinal endoscopic procedures; less than 20 cases have been reported since 1966. We present a case of an air embolus after esophagogastroduodenoscopy (EGD) that did not improve after treatment with hyperbaric oxygenation therapy. CASE REPORT: A 64 year-old female was admitted to the hospital for an elective EGD, which revealed distal esophageal strictures that were treated with balloon dilation. After the procedure, the patient was noted to have decreased responsiveness, a positive bilateral Babinski sign, and new-onset left facial droop. A head CT revealed an acute right MCA infarction with air in the cortical veins and superior sagittal sinus. A transthoracic echocardiogram with bubble study demonstrated a patent foramen ovale (PFO), and a diagnosis of paradoxical air embolism was made. The patient was electively intubated approximately nineteen hours after the EGD and arrangements were made for transfer to a referral hospital for hyperbaric oxygen therapy (HBO2T). Approximately 34 hours after the EGD, treatment with HBO2T was initiated (2.8 ATA, 132 minutes total treatment time). No improvement in neurologic function was noted after the hyperbaric treatment, and the patient was pronounced brain dead less than 24 hours later. Post-mortem examination revealed multiple cerebral and cerebellar infarcts with edema and herniation. DISCUSSION: Balloon dilation can cause microvascular injury to esophageal tissue, allowing air entry from the GI tract to the venous circulation. A PFO, as was present in this case, permits the transfer of venous air into the arterial circulation. HBO2T, which can minimize both the size of the air embolus and the associated inflammatory response, is of most benefit when performed within several hours of the inciting event. CONCLUSION: Air embolus is a rare complication of endoscopic procedures including EGD. Prompt treatment with HBO2T may limit the complications and improve clinical outcome.
Description: Abstract of the Undersea & Hyperbaric Medical Society 2008 Annual Scientific Meeting June 26-28, 2008 Salt Lake City Marriott Downtown, Salt Lake City, Utah.
URI: http://archive.rubicon-foundation.org/7892
Date: 2008

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  • UHMS Meeting Abstracts
    This is a collection of the published abstracts from the Undersea and Hyperbaric Medical Society (UHMS) annual meetings.

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