Clinical Case Summary
Introduction: Swelling of the parotid glands has previously been reported as a rare complication of peroral endoscopy. Several mechanisms have been proposed such as retention of secretions causing a blockage of the salivary ducts, venous congestion of the salivary glands, dehydration causing thick secretions, parasympathetic stimulation resulting in parotid vasodilation.
Case report: We report the case of 81‑year‑old male patient who presented with a 3-day history of melena and dizziness. The patient was hemodynamically stable (BP: 140/85 mmHg, HR: 89/min) with positive digital rectal exam for blood. The laboratory tests showed significant reduction in hematocrit (Hct: 21.2%, Hb: 7.3 g/dL). The patient was supported with intravenous fluids and transfusions of RBCs and within 24 hours from admission he underwent esophagogastroscopy, with local xylocaine spray, which revealed a Dieulafoy’s lesion inside a diafragmatocele (Figure 1) treated with adrenaline injection and endoclip placement. The procedure was uneventful, but after 24 hours the patient developed pain followed by swelling around left angle of mandible, without fever. On examination, there was swelling of left parotid gland (Figure 2), with tender on touch suggestive of parotitis, but there was no crepitus in the neck. Ultrasonography revealed diffusely swollen parotid gland (Figure 3), without salivary duct calculi, abscess, fluid collection or enlarged lymph nodes. The patient was hydrated and swelling disappeared spontaneously after 72 hours. He received a total of 3 units of RBCs during hospitalization, melena resolved and the patient was discharged home. No other complication was
noted during follow-up.
Conclusion: Upper gastrointestinal endoscopy is a procedure mostly uneventful. Parotid gland swelling is a rare complication of endoscopy and awareness of this benign condition can help relieve any apprehension that the patient and the endoscopist may have.
References
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