1. Tas, Adnan MD

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Dear Editor,


Upper gastrointestinal endoscopy (UGE) involves risk to patient safety. Complications of the UGE are hemorrhage, perforation, respiratory arrest, side effect of the sedative drugs, aspiration pneumonia, transient global amnesia, cerebral air embolism oral rash, facial purpura, damaging of crowned teeth, dislocation of the temporomandibular joint, infection, cardiac arrest, and death (Samer Ammar et al., 2003; Sayilir, Kurt, Ibis, et al., 2009; Sayilir, Kurt, Kacar, et al., 2009; Yuksel, Ekiz, Ekiz, Bas[low single comma quotation mark]ar & Yuksel, 2012). Herein, we present a case of periorbital ecchymosis as a complication of UGE. To our knowledge, periorbital ecchymosis (PE) has not been described as part of the clinical spectrum complication of UGE.


Upper gastrointestinal endoscopy was performed on a 70-year-old man because of epigastric pain. Oral lidocaine spray was administered before the procedure. Pangastritis and a bulbar ulcer were detected. He coughed and retched during the gastroscopic procedure. The patient manifested a periorbital ecchymosis in his left periorbital area (Figure 1). He denied any medication in his medical history. Laboratory test results were white blood cell count (7 x 109/L; [4-10] x 109/L), hemoglobin (14.5 g/L; [14-16 g/L]), platelet count (300 x 109/L; [150-350] x 109/L), prothrombin time (11 seconds; [10.5-14.5 seconds]), partial thromboplastin time (22 seconds; [20-35 seconds]), and international normalized ratio (0.9; [0.8-1.2]). Upon follow-up, the PE resolved within 15 days of the procedure.

Figure 1 - Click to enlarge in new windowFIGURE 1. Periorbital ecchymosis related to upper gastrointestinal endoscopy.

Periorbital ecchymosis has been described in patients with multiple myeloma, migraine, posterior peribulbar anesthesia, amyloidosis trauma, and tumor (Dober, Stranzinger, Kellenberger, & Huisman, 2007). After we excluded coagulopathy, periorbital hemorrhage was attributed to the patient's coughing, retching, and capillary fragility in the left lateral decubitus position. This position results in venous congestion and may contribute to the development of periorbital hemorrhage. Fragile capillaries can burst after stress (ie, coughing, retching), which may result in periorbital bleeding as in our case (Van Woerkom & van Toorn, 2000). Fortunately, PE related to UGE is rare and seems to be temporary.


Respectfully submitted,


Adnan Tas, MD


Specialist, Department of Gastroenterology


Osmaniye Public Hospital


Osmaniye, Turkey




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