Periorbital Ecchymosis (Raccoon Eye) and Orbital Hematoma following Endoscopic Retrograde Cholangiopancreatography

Abstract

Endoscopic retrograde cholangiopancreatography (ERCP) is a conventional technique for diagnosis and treatment of pancratobiliary diseases, which is associated with various complications, including pancreatitis, hemorrhage, cholangitis, perforation, and mortality. In our case, a 69-year-old woman with positive hepatobiliary symptoms underwent ERCP, at the end of which a rare complication (raccoon eye) occurred, which was hypothesized to be due to amyloidosis, but the patient refused to complete the diagnostic procedure and became symptom free after 3 weeks. Racoon eye or periorbital ecchymosis is caused by blood tracking into periorbital tissues, which is frequently observed after head trauma but is also observed in systemic diseases, such as amyloidosis, neuroblastoma, and surgical interventions. To the best of our knowledge, this is the first report of raccoon eye after ERCP; further reports will help to confirm that this complication should also be considered before performing ERCP and that complete diagnostic tests for the predisposing diseases prior to ERCP are necessary.

A 64-year-old woman with raccoon eyes following kidney biopsy: a case report

“…AL amyloidosis is the most common type of systemic amyloidosis, which is difficult to recognize because of the vague symptoms and range of manifestations. While, the key features of all kinds of amyloidosis is abnormal folding of a protein that is normally soluble and can be typical apple-green birefringence with polarized microscopy after Congo red dye [2,3]. As is known to all, there are several major forms of amyloidosis, including immunoglobulin light chain (AL) amyloidosis, amyloid A (AA) amyloidosis, dialysis-related amyloidosis, heritable amyloidosis.…”

Reply to: post‐emesis periorbital purpura in hyperemesis gravidarum

“…There have been reports of iatrogenic periorbital ecchymosis related to endoscopic techniques 3 and to continuous positive airway pressure therapy 4 …”

Bilateral proptosis: an unusual primary presentation of scurvy—a case report

“…Periorbital swelling associated with bluish discoloration is referred to as periorbital ecchymosis or raccoon eye. It is a manifestation of contusion and stretching of capillaries leading to rupture and tracking of blood into the periorbital tissues, causing blue or purple discolouration of the eyelids [1]. It is commonly the telltale sign of head and neck trauma including skull base fractures, soft tissue injuries and facial fractures with resultant hemorrhage [1].…”

“…In adults, migraine, amyloidosis, leukaemic deposits or multiple myeloma lesions are few common causes of periorbital ecchymosis apart from Valsalva manoeuvre which lead to increased venous pressure [1,4]. Underlying coagulopathy and bleeding diathesis, vascular malformations and iatrogenic causes can also lead to orbital hemorrhages [4].…”