A case of air embolism during endoscopic sphincterotomy

We report a rare case of air embolism related to endoscopic sphincterotomy. A 71-year-old woman was admitted to the hospital with acute cholecystitis and cholangitis associated with a common bile duct stone. She was treated with antibiotics and underwent endoscopic sphincterotomy for removal of the stone. Under sedation we initiated the sphincterotomy and incised the Vater papilla using a scalpel, before removing the stone using a basket catheter. A few minutes later, blood oxygen saturation suddenly dropped and treatment was arrested. CT showed air embolism in the hepatic vein, coronary artery, aorta and heart chamber. The patient was maintained in the left lateral decubitus position and underwent cardiac catheterization for degassing, but no gas was detected. After cardiac catheterization, air embolism visible on CT was reduced to a minimal amount within the hepatic vein. The patient was discharged without further sequelae. We consider it important that a doctor performs the endoscopy to ensure adequate knowledge of potential accidental disease during the procedure.