Year: 2025
Type: article
Study design: Case Report
Abstract: Case Description A 54-year-old male with no prior history of traumatic brain injury or nasopharyngeal disease underwent endoscopic retrograde cholangiopancreatography (ERCP) for a pancreatic space-occupying lesion. The procedure was performed under general anesthesia. In the postanesthetic recovery period, the patient rapidly developed severe neurological symptoms, presenting with left-sided mydriasis and a coma. An emergency computed tomography scan revealed pneumocephalus ([ Fig. 1A ] and [ B ]). Review of the intraprocedural imaging was then conducted. We noted that the pancreatic duct guidewire, after navigating the neck of the pancreas, had aberrantly protruded downwards ([ Fig. 2 ]). The multidisciplinary team subsequently ruled out other potential etiologies. They concluded that the most likely cause was iatrogenic CO 2 migration into the cranial cavity through an enterospinal fistula, a tract created by the initial puncture injury. Fortunately, the patient showed a full neurological recovery, regaining consciousness after 4 days with no lasting deficits. This case represents the first reported instance of pneumocephalus following an ERCP procedure. Fig. 1 Point bubble and patchy air shadow in the bilateral pterygoid process, pterygoid muscle,( A ) bilateral parapharyngeal space,( B ) mandibular ramus, and left submandibular area. Fig. 2 After the guidewire passed through the duodenal papilla, the pancreatic duct guidewire, after navigating the neck of the pancreas, had aberrantly protruded downwards. Publication History Article published online: 31 October 2025 © 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/) Thieme Medical and Scientific Publishers Pvt. Ltd. A-12, 2nd Floor, Sector 2, Noida-201301 UP, India
Source: Journal of Digestive Endoscopy
Authors: Jinghua Liang, Honghao Meng
Institutions: The First People's Hospital of Zhaoqing, Nanfang Hospital
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4415755322