Anaphylactoid reaction to intraoperative cholangiogram. Report of a case, review of literature, and guidelines for prevention.
Anaphylactoid (pseudoallergic, idiosyncratic) reactions are a well recognized but uncommon consequence to radiographic contrast media. Most reported reactions are to intravascular injections, but systemic reactions to nonvascular injections of radiographic contrast also are well documented. Reactions to nonvascular radiographic contrast media have been reported during or after instillation of radiographic contrast into a multitude of nonvascular body compartments, but not with intraoperative cholangiogram. We describe a case of a systemic anaphylactoid reaction caused by intraoperative cholangiogram during laparoscopic cholecystectomy. We then discuss the clinical presentation, suspected etiology, and treatment of these idiosyncratic reactions as well as established guidelines for prevention in patients at risk.
Moskovitz
A H
AH
Department of Surgery, University of Washington, 1959 N.E. Pacific Street, P.O. Box 356410, Seattle, WA. 98195, USA.
Bush
W H
WH
Horvath
K D
KD
D000368:Aged; D000707:Anaphylaxis / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D002758:Cholangiography / Q000009:adverse effects*; D017081:Cholecystectomy, Laparoscopic; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D007432:Intraoperative Period; D012306:Risk