Massive cerebral air embolism via percutaneous transhepatic biliary drainage tube: A case report

초록

Background/Purpose: Cerebral air embolism resulting from portal venous gas rarely occurs during or after invasive procedures disrupting gastrointestinal or hepatobiliary structures, and the possible causes are endoscopic procedures, liver biopsy, or percutaneous transhepatic biliary drainage (PTBD). We report a rare case of fatal cerebral air embolism that occurred after a series of percutaneous transhepatic biliary drainage (PTBD) tube insertion. Materials & Methods: The patient was a 50-year-old female with a history of cholecystectomy, liver wedge resection and hepaticojejunostomy for gallbladder cancer. She presented with sudden deterioration in mental state one week after the PTBD tube change. Results: Extensive cerebral air embolism and acute cerebral infarction in affected regions were immediately diagnosed using a brain CT and brain diffusion-weighted imaging. Despite the use of hyperbaric oxygen therapy and medical treatment including vasopressors, the patient died eventually due to massive systemic air embolism. Conclusions: There is no case in literature to date regarding cerebral air embolism in connection to percutaneous transhepatic biliary drainage (PTBD) with pronounced brain CT and MRI images. We reviewed the formerly reported fatal cases associated with endoscopic hepatobiliary procedures and accessed possible mechanism and the potential causes of the event.