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Enfisema subcutáneo generalizado más neumotórax a tensión posterior a CPRE

Abstract:

Endoscopic retrograde cholangiography (ERCP) is an invasive technique that allows diagnosing and treating pathologies of the bile duct. The rate of complications is low returning to the safe procedure, not free of complications such as pancreatitis, bleeding, cholangitis and even perforation (incidence less than 1.5%). We present the clinical case of a male patient, with pain in the right hypochondrium, vomiting and fever that presents dilatation of the distal end of the common bile duct due to lithiasic cause evidenced by cholangioresonance. It is programmed for CPR, trying cannulation without papillotomy; During the procedure, the patient presents subcutaneous emphysema and tension pneumothorax, requiring emergency treatment. Surgical management was decided twelve hours after ERCP due to the marked hemodynamic instability of the patient; In the intraoperative period and in a subsequent endoscopy, there was no evidence of a macroscopic lesion that justified the clinical and radiological images presented by the patient. Surgical treatment of duodenal perforation wasperformed, which forced a stay in intensive therapy for 11 days. It is complemented by a bibliographic review of post-ERCP complications.