Unusual occurrence of massive subcutaneous emphysema during ERCP under general anaesthesia

Jaiswal, Santosh Kumar; Sreevastava, DK; Datta, Rashmi; Lamba, Navdeep Singh

doi:10.4103/0019-5049.123340

Cited by 5 publications

(1 citation statement)

References 8 publications

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“…[ 8 11 ] In those cases without overt perforation, it is postulated that trauma to the duodenal wall by the endoscope causes the insufflated air under pressure to enter the mucosa and track along the perineural and perivascular sheaths to enter the mediastinum. [ 12 ] However, pneumomediastinum with associated orbital emphysema without any cervicofacial trauma is extremely rare. Aydin et al reported the case of a 63-year-old woman who developed bilateral periorbital emphysema associated with diffuse mediastinal and subcutaneous emphysema following ERCP.…”

Section: Discussionmentioning

confidence: 99%

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

Lekha

Leelakrishnan

Karuppannasamy

et al. 2017

J Ophthalmic Vis Res

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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.

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Section: Discussionmentioning

confidence: 99%

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

Lekha

Leelakrishnan

Karuppannasamy

et al. 2017

J Ophthalmic Vis Res

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Pneumomediastinum presenting as left periorbital subcutaneous emphysema

Orton

Collette

2015

The American Journal of Emergency Medicine

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The Diagnosis and Management of Patient with Delayed Symptoms from a Tracheal Tear

Greilich

Gasanova

Farrell³

et al. 2016

A & A Case Reports

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Development of subcutaneous emphysema after gastrointestinal endoscopy with general anesthesia presents a diagnostic conundrum. We discuss the management of a patient who experienced significant vomiting followed by neck and facial swelling with crepitus and shortness of breath after the endoscopic retrograde cholangiopancreatography. The presence of respiratory distress usually suggests that head and neck subcutaneous emphysema is most likely associated with pneumothorax and/or pneumomediastinum. We discuss the prevention, differential diagnosis, and current management of tracheal tears including subcutaneous emphysema.

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Unusual occurrence of massive subcutaneous emphysema during ERCP under general anaesthesia

Cited by 5 publications

References 8 publications

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

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

Pneumomediastinum presenting as left periorbital subcutaneous emphysema

The Diagnosis and Management of Patient with Delayed Symptoms from a Tracheal Tear

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