Shin SY, Yeon HJ, Lee SO, Lee JR, Leem G, Han SJ. Fatal air embolism during intestinal endoscopy in Kasai portoenterostomy for biliary atresia: A case report. World J Gastrointest Endosc 2025; 17(7): 105773 [DOI: 10.4253/wjge.v17.i7.105773]
Corresponding Author of This Article
Seok Joo Han, MD, PhD, Professor, Division of Pediatric Surgery, Department of Surgery, Severance Children’s Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seoul 03722, Seodaemun-gu, South Korea. sjhan@yuhs.ac
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Endosc. Jul 16, 2025; 17(7): 105773 Published online Jul 16, 2025. doi: 10.4253/wjge.v17.i7.105773
Fatal air embolism during intestinal endoscopy in Kasai portoenterostomy for biliary atresia: A case report
So Young Shin, Hee Jin Yeon, Sang On Lee, Jeong Rim Lee, Galam Leem, Seok Joo Han
So Young Shin, Seok Joo Han, Division of Pediatric Surgery, Department of Surgery, Severance Children’s Hospital, Yonsei University College of Medicine, Seoul 03722, Seodaemun-gu, South Korea
Hee Jin Yeon, Department of Surgery, Konyang University College of Medicine, Daejeon 35365, Seo-Gu, South Korea
Sang On Lee, Department of Cardiovascular Surgery, Yonsei University College of Medicine, Seoul 03722, Seodaemun-gu, South Korea
Jeong Rim Lee, Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul 03722, Seodaemun-gu, South Korea
Galam Leem, Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, Seodaemun-gu, South Korea
Author contributions: Shin SY and Han SJ designed and performed the literature review and wrote the case report; Yeon HJ, Lee SO, Lee JR, Leem G and Han SJ were involved with the surgery and managed the patient.
Informed consent statement: The patient and her parents provided written informed consent prior to the surgery.
Conflict-of-interest statement: The authors declare no conflicts of interest related to this case report.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Seok Joo Han, MD, PhD, Professor, Division of Pediatric Surgery, Department of Surgery, Severance Children’s Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seoul 03722, Seodaemun-gu, South Korea. sjhan@yuhs.ac
Received: February 7, 2025 Revised: April 2, 2025 Accepted: June 7, 2025 Published online: July 16, 2025 Processing time: 153 Days and 1.1 Hours
Abstract
BACKGROUND
Air embolism (AE) is a rare but potentially fatal complication of intestinal endoscopy (IE).
CASE SUMMARY
Herein, we report the case of an 18-year-old woman who underwent a successful Kasai portoenterostomy (KPE) for biliary atresia but died of AE during intraoperative IE for stone removal at the portoenterostomy site. Our review of the English literature identified only four similar cases of fatal AE during IE in patients undergoing KPE. The common clinical setting in the five patients, including our case, was high-pressure air insufflation into the blind closed afferent loop of the KPE to secure visibility. We hypothesize that the highly pressurized air injected into the closed loop entered the bile canaliculi—previously opened by KPE for bile drainage—passed through the tiny, microscopic pores of the fenestrated liver sinusoid endothelial cells, and finally entered the bloodstream with ease, resulting in fatal AE.
CONCLUSION
Meticulous performance of IE, especially on the KPE blind loop, is warranted owing to the risk of AE.
Core Tip: Low-pressure CO2 insufflation instead of high-pressure air insufflation is more suitable during intestinal endoscopy in patients with Kasai portoenterostomy to prevent fatal air embolism.
