An Endoscopic Retrograde Cholangiopancreatography-Induced Subperiostal Orbital Hemorrhage
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".