Pneumocephalus Following Endoscopic Retrograde Cholangiopancreatography

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.