Periorbital and mediastinal emphysema after upper gastrointestinal endoscopy: Case report of a rare complication

Purpose: to report a rare case of periorbital emphysema concurrent with cervicofacial and mediastinal emphysema in an elderly woman who underwent upper gastrointestinal endoscopy for chronic liver disease. case report: an elderly woman with decompensated chronic liver disease presented with features of periorbital,facial,and mediastinal emphysema,characterized with crepitant swelling over the right periorbital area,face,neck,and mediastinum after undergoing upper gastrointestinal endoscopy. there was no history of trauma or valsalva maneuver. ocular findings were stable with no evidence of orbital compartmental syndrome. urgent computed tomography scans of the orbit and chest were performed,and emergency systemic treatment with nasogastric decompression and antibiotics was initiated. however,she suddenly collapsed and succumbed despite all resuscitative efforts. conclusion: our case demonstrates that periorbital emphysema can occur following procedures such as upper gastrointestinal endoscopy,in the eyes without history of local trauma. this complication should be suspected especially if there is associated cervicofacial and mediastinal emphysema. subcutaneous emphysema is usually self-resolving; however,extension of air into deeper planes can cause dangerous complications such as blindness due to orbital emphysema or mortality due to mediastinal emphysema. hence,prompt diagnosis and urgent intervention are crucial to avoid vision and life threatening complications. lekha thankappan 1 department of ophthalmology,psg institute of medical sciences and research,coimbatore,tamilnadu venkatakrishnan leelakrishnan 2 department of gastroenterology,psg institute of medical sciences and research,coimbatore,tamilnadu divya karuppannasamy 3 department of ophthalmology,psg institute of medical sciences and research,coimbatore,tamilnadu perumal lavanya 4 department of ophthalmology,psg institute of medical sciences and research,coimbatore,tamilnadu zimmer-galler ie,bartley gb. orbital emphysema: case reports and review of the literature. mayo clin proc 1994;69:115-121. hunts jh,patrinely jr,holds jb,anderson rl. orbital emphysema. staging and acute management. ophthalmology 1994;101:960-966. abdelrahman h,shunni a,el-menyar a,ajaj a,afifi i,zarour a,et al. mediastinal emphysema following fracture of the orbital floor. j surg case rep 2014:rju032. saleem a,chaudhary a,ali mu,iqbal zh. cervicofacial emphysema. j coll physicians surg pak 2010;20:556-557. mather aj,stoykewych aa,curran jb. cervicofacial and mediastinal emphysema complicating a dental procedure. j can dent assoc 2006;72:565-568. ong wc,lim tc,lim j,sundar g. cervicofacial,retropharyngeal and mediastinal emphysema: a complication of orbital fracture. asian j surg 2005;28:305-308. hiraoka t,ogami t,okamoto f,oshika t. compressed air blast injury with palpebral,orbital,facial,cervical,and mediastinal emphysema through an eyelid laceration: a case report and review of literature. bmc ophthalmol 2013;13:68. schiavon ll,rodrigues ra,nakao fs,sena vod,ferrari ap,jr edl. subcutaneous emphysema,pneumothorax and pneumomediastinum following endoscopic sphincterotomy. gastroenterol res 2010;3:216-218. yen hh,chen yy. pneumomediastinum,pneumoperitoneum,pneumoretroperitoneum,and subcutaneous emphysema after ultrathin endoscopy. endoscopy 2011;43:e49-e50. minocha a,richards rj. pneumomediastinum as a complication of upper gastrointestinal endoscopy. j emerg med 1991;9:325-329. aydin m,kisli e,ozgoren e,soylemez o,baser m,aslaner a. mediastinal and retro-orbital emphysema following an uncomplicated endoscopic sphincterotomy. indian j surg 2005;67:147-149. jaiswal sk,sreevastava dk,datta r,lamba ns. unusual occurrence of massive subcutaneous emphysema during ercp under general anaesthesia. indian j anaesth 2013;57:615-617. © 2017 journal of ophthalmic and vision research published by wolters kluwer - medknow.