Case Report Air Embolism after Endoscopic Retrograde Cholangiopancreatography in a Patient with Budd Chiari Syndrome Beatriz Wills-Sanin, 1 Yenny R. Cárdenas, 2 Lucas Polanco, 2 Oscar Rivero, 2 Sebastian Suarez, 2 and Andrés F. Buitrago 1 1 Department of Critical Care, University Hospital Fundaci´ on Santa Fe de Bogot´ a, Calle 119 No. 7-75, A.A. 220246, Bogot´ a, Colombia 2 University Hospital Fundaci´ on Santa Fe de Bogot´ a, Calle 119 No. 7-75, A.A. 220246, Bogot´ a, Colombia Correspondence should be addressed to Andr´ es F. Buitrago; abuitrag@uniandes.edu.co Received 25 July 2014; Accepted 3 November 2014; Published 18 November 2014 Academic Editor: Gerhard Pichler Copyright © 2014 Beatriz Wills-Sanin et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Endoscopic retrograde cholangiopancreatography is a procedure commonly used for the diagnosis and treatment of various pancreatic and biliary diseases. Air embolism is a rare complication, which may be associated with this procedure. Tis condition can be manifested as cardiopulmonary instability and/or neurological symptoms. Known risk factors include: sphincterotomy; application of air with high intramural pressure; anatomic abnormalities; and chronic hepatobiliary infammation. It is important for the health-care staf, including anesthesiologists, interventional gastroenterologists, and critical care specialists, amongst others, to promptly recognize air embolism and to initiate therapy in a timely fashion, thus preventing potentially fatal outcomes. We submit a brief review of the literature and a case report of air embolism which occurred in the immediate postoperative stage of an endoscopic retrograde cholangiopancreatography, performed in a woman with a history of liver transplantation due to Budd Chiari syndrome and biliary stricture. 1. Introduction Endoscopic retrograde cholangiopancreatography (ERCP) has become a primary tool for the diagnosis and treatment of ductal pancreatic and biliary tree pathology. Due to its complexity and technical demands, the endoscopic technique has a higher rate of complications than other diagnostic procedures [1], some of which include post-ERCP pancreati- tis, cholangitis, bleeding or perforation afer sphincterotomy. However, endoscopists are familiar with these adverse events, making ERCP a minimally invasive procedure with a good safety profle. Nonetheless, other less common situations— such as air embolism—can result in fatal outcomes. Tere- fore, it is essential for health professionals to identify risk fac- tors and clinical manifestations of post-ERCP air embolism to improve its management [2]. 2. Case Presentation A 55-year-old female with a history of liver transplant six years ago due to Budd Chiari syndrome is admitted to the emergency room with progressive right-upper-quadrant pain, vomit and diarrhea. Her history included multiple episodes of biliary strictures managed with a self-expanding coated stent implant. At admission, her vital signs were stable, she had adequate oxygen saturation, and she had no fever. Lab reports evidenced elevated alkaline phosphatase and normal bilirubin levels. To evaluate a probable biliary obstructive syndrome, an abdominal ultrasound and a magnetic resonance cholangi- opancreatography were performed (Figure 1), which showed obstruction of the bile duct, secondary expansion, and presence of multiple gallstones. Due to the high risk of Hindawi Publishing Corporation Case Reports in Critical Care Volume 2014, Article ID 205081, 4 pages http://dx.doi.org/10.1155/2014/205081