An Endoscopic Retrograde Cholangiopancreatography-Induced Subperiostal Orbital Hemorrhage
Notice bibliographique
Résumé
Subperiostal orbital hemorrhage is not a complication reported in ERCP literature. We reviewed multiple cases reports or small retrospectives series of subperiostal hematoma but only one case of bilateral spontaneous orbital hemorrhage with symptoms onset immediately after ERCP; our case is then the second reporting this complication. A 38-years-old female was referred for symptomatic choledocholithiasis (painless jaundice, prurit, dark urine, acholic feces). Abdominal ultrasonography confirmed a 12 mm choledocholithiasis with 19 mm bile duct dilation. ERCP were performed for numerous lithiases difficult to extract with minimal tolerance by the patient. She had protracted valsalva on the fourth CPRE. She immediatly reported left ocular pain, diplopia and retroocular pressure as if her eye was going to pop out. Physical exam revealed left eye ptosis, tissue swelling, exophthalmia, diplopia with extremely painfull and partial eye movement. Urgent orbital contrast-enhanced computed tomography scanning was ordered. A left superior subperiosteal hemorrhage of 30 mm width by 32 mm anteroposterior by 10 mm vertical was shown, pushing inferiorly conal muscles, optical nerve and intraorbital fat resulting in grade II exophtalmia (fig 1-4). There were no nerve or vessel compromise and no active bleeding. Radiologist raised concern about an underlying orbital bone anomaly without obvious mass.Figure 1Figure 2Figure 3Blood work the day of the ERPC were; International normalized ratio 1.3, platelets 381, normal renal clairance. Thromboprophylactic heparin was suspended before the ERCP. She received 2 fresh frozen plasma to correct her minimaly increased INR after the hematoma was confirmed. The patient was treated with intraocular latanoprost (prostaglandin analog) 0.005% 1 drop hs and eye rest. She already did better the day after with partial pain resolution, minimal oblic diplopia and no other vision perturbation. Eleven days later an orbital magnetic resonance showed partial resorption of the hematoma, diminution of the mass effect with residual grade I exophthalmia and no underlying mass was shown. Patient was still jaundiced and magnetic resonance cholangiopancreatography confirmed persistence of choledocholithiasis. A subsequent ERCP was done under general anesthesia and stones were removed with mechanical lithotripsy. Six weeks later, the patient blood work was normal and she was asymptomatic. Subsequently, a 18 months follow-up orbital magnetic resonance was completely normal. In conclusion subperiostal orbital hemorrhage is an extremely rare complication of ERCP. ERCP endoscopits should all be aware of its nature because presentation can be less florid than our case and urgent surgical management may be needed to relieve vessel/vascular compromise.
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Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
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