S4600 Subconjunctival Hemorrhage as a Rare Complication of Esophagogastroduodenoscopy

Introduction: Esophagogastroduodenoscopy (EGD) is one of the most widely performed procedures in modern medical practice, serving both diagnostic and therapeutic purposes. Common complications are typically linked to cardiopulmonary issues and anesthetic concerns. We present a case of subconjunctival hemorrhage (SCH), a rare and unanticipated complication during an endoscopic procedure in a healthy young man. Case Description/Methods: A 22-year-old man with a prolapsed disc on intermittent nonsteroidal anti-inflammatory drug use presented to the emergency department with acute, severe hematemesis. He appeared pale, diaphoretic and exhibited tachycardia and hypotension. He was stabilized with IV fluids and started on proton pump inhibitor infusion. The hemoglobin level was 7.2 g/dL. Platelet count and coagulation profiles were normal. EGD was performed the next day without sedation, as the patient deferred it. The endoscope was lubricated with lidocaine gel; the initial entry till mid-esophagus was smooth. On advancement, the patient experienced retching. Fundal gastritis was noted. On completion of the procedure, severe diffuse scleral redness and periorbital swelling were noted bilaterally. An urgent ophthalmological review confirmed bilateral SCH, and conservative management was advised. The SCH resolved within 2 weeks. After a month, EGD was repeated with sedation to reassess the erosion, which was uneventful. Discussion: EGD is recognized for its exceptional safety profile, with rare complications such as infection (<.3%), bleeding (<.1%), and cardiopulmonary complications (<.1%). Incidence of SCH after an endoscopy is remarkably rare and last reported in 2001. SCH’s risk factors are systemic vascular and bleeding disorders, thrombocytopenia, liver failure, or current usage of antiplatelet agents or anticoagulants. None of them were noticed in our case. Retching during EGD likely contributed to the rupture of conjunctival blood vessels. Gastroenterologists should be vigilant when performing EGD, especially in patients with the aforementioned risk factors. In such cases, careful patient assessment, pre-procedure optimization, and consideration of sedation to minimize retching are key factors in reducing adverse events.