Lekha Thankappan, Venkatakrishnan Leelakrishnan, Divya Karuppannasamy, Lavanya Perumal
Department of Ophthalmology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamilnadu, India.
Department of Gastroenterology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamilnadu, India.
J Ophthalmic Vis Res. 2017 Jul-Sep;12(3):345-347. doi: 10.4103/jovr.jovr_270_15.
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.
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.
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.
报告一例老年女性在因慢性肝病接受上消化道内镜检查后并发眶周气肿伴颈面部及纵隔气肿的罕见病例。
一名失代偿期慢性肝病老年女性，在接受上消化道内镜检查后，出现眶周、面部及纵隔气肿表现，其特征为右眶周区域、面部、颈部及纵隔出现捻发音性肿胀。无外伤或瓦尔萨尔瓦动作史。眼部检查结果稳定，无眼眶间隔综合征证据。紧急进行了眼眶和胸部计算机断层扫描，并开始了鼻胃减压和抗生素的紧急全身治疗。然而，尽管全力抢救，她仍突然倒下并死亡。
我们的病例表明，在无局部外伤史的情况下，上消化道内镜检查等操作后可发生眶周气肿。特别是当伴有颈面部及纵隔气肿时，应怀疑这种并发症。皮下气肿通常可自行消退；然而，气体扩散至更深层面可导致危险并发症，如因眼眶气肿导致失明或因纵隔气肿导致死亡。因此，及时诊断和紧急干预对于避免视力和生命威胁并发症至关重要。
