Secondary Logo

Journal Logo

Post-Endoscopy Sialadenitis

Molakatalla, Phani MD; Govil, Yogesh MD

doi: 10.14309/crj.2015.2
ACG CASE REPORTS JOURNAL: IMAGE | ENDOSCOPY
Free

Division of Gastroenterology and Nutrition, Department of Internal Medicine, Einstein Medical Center, Philadelphia, PA

Published online: January 16, 2015.

Correspondence: Phani Molakatalla, 5501 Old York Rd, Klein Building, Suite 363, Philadelphia, PA 19141 (molakatp@einstein.edu).

Figure

Figure

Back to Top | Article Outline

Case Report

A 70-year-old woman reporting 1 year of non-progressive intermittent solid dysphagia underwent an outpatient endoscopy. Endoscopy was normal, and a 54-French bougie dilator was empirically passed, which encountered moderate resistance in oral cavity. On withdrawal, no blood was noted. The dilator passed freely on the second attempt. Subsequent screening colonoscopy was uneventful. Five hours after discharge, she returned with odynophagia and pain from a tender right submandibular swelling (Figure 1). Contrast computed tomography of the neck showed submandibular sialadenitis with adjacent cellulitis (Figure 2). After 12 hours of IV clindamycin, hot compresses, and hydration, she was discharged. Given the remarkable improvement in cellulitis, we prescribed a 72-hour course of empiric oral amoxicillin/clavulanate.1 On phone follow-up, she reported total resolution of the swelling after the antibiotics.

Figure 1.

Figure 1.

Figure 2.

Figure 2.

Presentation of post-endoscopy sialadenitis is concerning for cervical esophageal/pharyngeal perforation. Proposed mechanisms of sialadentitis include drug reactions, coughing, or parasympathetic stimulation leading to increased gland secretions or vascularity, and ductal blockage due to thickening of secretions from dehydration.2-4 It typically presents with parotid and/or submandibular swelling during or immediately after endoscopy, resolving over minutes to hours.2-4 In our case, the initial attempt at dilation could have traumatized the submandibular gland duct opening, triggering inflammation, with dehydration from her colonoscopy preparation contributing. Our case differed from prior reports by delayed onset, intense inflammation, adjacent cellulitis, prolonged course, and bougie dilatation. Selected cases without evidence of concomitant infection may be managed with supportive treatment inclusive of warm compresses and hydration.

Back to Top | Article Outline

Disclosures

Author contributions: P. Molakatalla prepared the manuscript, and is the article guarantor. Y. Govil edited the manuscript and mentored the process.

Financial disclosure: None to report.

Informed consent was obtained for this case report.

Previous Presentation: This case report was previously presented as a poster at the ACG Annual Scientific Meeting; October 20-22, 2014; Philadelphia, Pennsylvania.

Acknowledgement: The authors thank Robert S. Dudnick, MD, for his support throughout patient management.

Received: September 24, 2014; Accepted: December 16, 2014

Back to Top | Article Outline

References

1. Ziccardi V, Molloy PJ. Parotid swelling after endoscopy. Gastrointest Endosc.1992;38(4):520.
2. Bonchek LI. Salivary gland enlargement during induction of anesthesia. JAMA. 1969;209(11):1716-8.
3. Shields HM, Soloway RD, Long WB, Weiss JB. Bilateral recurrent parotid swelling after endoscopy. Gastroenterology. 1977;73(1):164-5.
4. Slaughter RL. Parotid gland swelling developing during peroral endoscopy. Gastrointest Endosc. 1975;22:38-9.
Back to Top | Article Outline

Publish your work in ACG Case Reports Journal

ACG Case Reports Journal is a peer-reviewed, open-access publication that provides GI fellows, private practice clinicians, and other members of the health care team an opportunity to share interesting case reports with their peers and with leaders in the field. Visit http://acgcasereports.gi.org for submission guidelines. Submit your manuscript online at http://mc.manuscriptcentral.com/acgcr.

© 2015 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The American College of Gastroenterology.