Spontaneous rupture of the esophagus presenting with unilateral proptosis

Orbital Emphysema: Case Reports and Review of the Literature

“…Unilateral orbital emphysema and proptosis have been described as the initial features of Boerhaave's syndrome (spontaneous rupture of the esophagus). 44 One patient had pneumomediastinum, subcutaneous emphysema of the chest, and other typical clinical findings of a ruptured esophagus. The investigators postulated that the force of esophageal air was great enough to push air along fasciai planes and into orbital tissues along a route similar to that in the previously described cases of pulmonary barotrauma.…”

Unilateral Periorbital and Cervical Subcutaneous Emphysema Following Extraperitoneal Laparoscopic Radical Prostatectomy

“…In more obese patients with thicker subcutaneous tissues, it is possible that the trocar cone does not reach the depth required to form a tight seal, resulting in leakage of carbon dioxide into the local subcutaneous tissue, and subsequently to more distal sites depending upon procedural duration, insufflation pressure, and subcutaneous tissue resistance [9]. Periorbital emphysema is most commonly observed due to disruption in the integrity of the orbital walls, most commonly through trauma with associated orbital or sinus fractures [6,10]. Periorbital and facial emphysema has also been associated with dental procedures and use of an air-andwater-cooled turbine burr drill [11].…”

“…Inferiorly, the visceral space extends with the esophagus through the diaphragmatic hiatus into the retroperitoneal soft tissues [7]. This pathway is elegantly displayed by a case report of spontaneous rupture of the esophagus (Boerhaave's Syndrome) manifesting as mediastinal emphysema with associated periorbital crepitation over the patient's left eye [10]. Laparoscopic radical prostatectomy, however, is an extra peritoneal procedure focused in the retropubic space.…”