Supervisors info:
Ευαγγελία Κουσκούνη, Ομότιμη καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ, Επιβλέπουσα
Θεόδωρος Ξάνθος, Καθηγητής, Ιατρική Σχολή, Ευρωπαϊκό Πανεπιστήμιο Κύπρου
Νικολέττα Ιακωβίδου, Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Summary:
Introduction: Common complications after endoscopic retrograde cholangiopancreatography (ERCP) are pancreatitis, hemorrhage, perforation, and/or cholangitis. An unusual complication is a post-ERCP pneumothorax due to retroperitoneal duodenal perforation.
Materials and methods: A systematic literature search was conducted at PubMed, Scopus, and Cochrane library from 1980 up to 11/06/2019.
Results: 101 articles were found. After reviewing the articles a total of 34 cases were recognized as presenting with post-ERCP pneumothorax. 82,4 were female patients with a mean age of 64,3 (SD=20,2). The most frequent indication for ERCP was choledocholithiasis (55.9%). Pneumothorax was diagnosed with fluoroscopy during the procedure in 17,6%, while the rest 79,4% was diagnosed with chest X-ray and Computer Tomography. Pneumothorax was bilateral in 52,9% of cases and right-sided in 41,2%, while a small amount presented with tension pneumothorax (5,9%). Most common clinical signs were subcutaneous emphysema (64,7%), dyspnoea (52,9%), and sudden drop in oxygen saturation (38,2%). Sudden cardiac arrest was a rare incidence.
Conclusions: Post-ERCP pneumothorax is quite rare as a complication, has a dramatic clinical onset, and usually staggers medical staff. Sudden onset of tachypnea, subcutaneous emphysema, and drop in oxygen saturation should immediately raise suspicion for this type of complication.
Keywords:
Endoscopic retrograde cholangiopancreatography, ERCP, Complication, Perforation, Pneumothorax
