Logo American Journal of Case Reports

Call: 1.631.629.4328
Mon-Fri 10 am - 2 pm EST

Contact Us

Logo American Journal of Case Reports Logo American Journal of Case Reports Logo American Journal of Case Reports

31 October 2021: Articles  Saudi Arabia

Uvular Necrosis Following Esophagogastroduodenoscopy: A Case Report

Challenging differential diagnosis, Unusual or unexpected effect of treatment, Diagnostic / therapeutic accidents, Rare disease, Adverse events of drug therapy, Educational Purpose (only if useful for a systematic review or synthesis)

Hisham S. AlMomen1ABDEF*, Fuad Maufa2DE, Mohammad AlAwamy3DE

DOI: 10.12659/AJCR.933556

Am J Case Rep 2021; 22:e933556



BACKGROUND: Uvular necrosis is an uncommon complication of esophagogastroduodenoscopy. It usually presents with sore throat, fever, foreign-body sensation, and odynophagia following esophagogastroduodenoscopy. It occurs due to impairment of local circulation, which is caused by impingement of the uvula between the endoscope and the hard palate. It may also arise from excessive suctioning of the area surrounding the uvula. We present a case of uvular necrosis following esophagogastroduodenoscopy and describe current strategies to prevent this rare complication.

CASE REPORT: A 19-year-old man presented with a 4-day history of odynophagia, severe sore throat, and foreign-body sensation that started within 24 h after esophagogastroduodenoscopy. Uvular necrosis was observed on physical examination. The patient was treated conservatively with nonsteroidal anti-inflammatory drugs and antibiotics, and his symptoms resolved completely.

CONCLUSIONS: We believe that this is the sixth reported case of uvular necrosis following an uncomplicated diagnostic esophagogastroduodenoscopy in a young patient. Esophagogastroduodenoscopy is a routine procedure performed by gastroenterologists. Uvular necrosis can occur as a rare complication of esophagogastroduodenoscopy; therefore, it is important to monitor patients for odynophagia and abnormal foreign-body sensation following the procedure for at least 72 h. Uvular necrosis should be suspected if odynophagia persists after this period despite adequate treatment with conventional analgesics. Prompt diagnosis and management can relieve the patient’s symptoms, given that uvular necrosis is a self-limiting complication with a good prognosis.

Keywords: Endoscopes, Gastrointestinal, Necrosis, Pharyngitis, Uvula, Cleft Soft Palate, Mucous Membrane, Endoscopy, Digestive System, Analgesics, Humans, Male, young adult


Uvular necrosis is a rare complication of esophagogastroduodenoscopy (EGD). It may occur due to impairment of local circulation from the impingement of the uvula between the endoscope and the hard palate. Moreover, this adverse event may also occur with continuous suctioning of the throat around the area of the uvula [1]. Uvular necrosis is recognized by the characteristic black discoloration of the uvula with yellow exudates, along with sloughing of the mucosa and erythema of the soft palate on clinical examination of the throat.

Case Report

A 19-year-old man with no comorbidities, prior surgery, or history of gastrointestinal (GI) illness was referred to the Gastroenterology Department for investigation of iron deficiency anemia. He was a non-smoker and had no history of alcohol use or family history of GI malignancy. He had not experienced symptoms of anemia before. A physical examination showed unremarkable findings. As a part of the work-up of iron deficiency, EGD and colonoscopy were performed under anesthesia using a combination of topical lidocaine, a benzodiazepine, and a short-acting opiate. Both procedures were performed without any immediate complications. EGD showed a normal GI tract up to the second part of the duodenum. Colonoscopy also revealed normal findings. No biopsies were obtained during either procedure. The patient was discharged after 1-h observation in the recovery unit. The following day, he presented to the local emergency department with severe pain and foreign-body sensation in his throat. He was unable to eat, drink, or swallow his saliva because of severe throat pain. Black discoloration of the uvula was observed during throat examination, along with erythema of the soft palate (Figure 1). The patient visited his family physician and the Gastroenterology Department after 3 days. Thereafter, he was treated with analgesics (nonsteroidal anti-inflammatory drugs) and antibiotics (amoxicillin/clavulanic acid). A diagnosis of uvular necrosis was made based on the patient’s medical history, physical examination findings, and recent endoscopy history. The patient was treated conservatively and was able to resume oral intake of food 4 days after symptom onset (Figure 2). Two weeks later, the patient was followed up at the gastroenterology clinic. His throat symptoms had resolved completely, although his uvula was observed to be shorter than before (Figure 3).


As uvular necrosis is an extremely rare complication following EGD, and only a few cases have been reported in the literature to date [1–4]. To the best of our knowledge, our study reports the sixth case of uvular necrosis following an uncomplicated diagnostic esophagogastroduodenoscopy in a young patient.

Throat pain is a common post-EGD problem and resolves within 1–2 days after the procedure [2,3]. The etiology of uvular necrosis is related to one of the following causes: obstruction of the uvular blood supply due to compression between the hard palate and the shaft of the endoscope [1], suctioning trauma that can occur while withdrawing the endoscope, excessive suctioning with the Yankauer tip during the procedure [5], or iatrogenic trauma incurring during clearance of airways. Uvular necrosis has been reported to occur as an adverse event associated with other procedures and treatments [1], including endotracheal intubation [2], bronchoscopy, and endoscopic retrograde cholangiopancreatography (ERCP) [6–10]. The risk factors consistently reported in the literature are presence of an elongated uvula, longer duration of procedures, higher suction pressures, bacterial infection, allergic reaction, and trauma. Uvular necrosis can be conservatively treated by analgesics and/or antibiotics to relieve patient discomfort [4]. It is a self-limiting complication with a good prognosis.


Uvular necrosis is a rare complication of upper gastrointestinal endoscopy; therefore, our study findings can provide a reference for clinicians, especially gastroenterologists, to consider this complication when performing EGD in their daily clinical practice. Moreover, uvular necrosis should be considered in the differential diagnoses of persistent (> 72 h) sore throat or odynophagia following EGD. A pre-procedural throat examination should be performed for all patients undergoing upper gastrointestinal endoscopy to identify those at risk for uvular injury. It is also desirable to consider the procedural duration and avoid long procedures. The suctioning pressure during endoscopy can also be reduced to avoid uvular injury. During endoscopy, avoidance of blind suctioning and assurance of appropriate positioning of the endoscope can prevent uvula necrosis [4]. Furthermore, excessive suctioning should be avoided in the oropharyngeal area while withdrawing the endoscope [1]. Surgeons should also apply suction on either side of the mouth to avoid direct suction of the uvula, which is crucial for preventing this condition. While uvular necrosis resolves spontaneously within 14 days, it is important to recognize the risk factors and instruct patients about possible adverse events, so that they may benefit from conservative management and reassurance.


1.. Tang SJ, Kanwal F, Gralnek IM, Uvular necrosis after upper endoscopy: A case report and review of the literature: Endoscopy, 2002; 34; 585-87

2.. Digby-Bell J, Zeki S, Uvular necrosis following diagnostic gastroscopy: BMJ Case Rep, 2017; 2017; bcr2017221959

3.. Shores NJ, Bloomfeld RS, Images in clinical medicine. Uvular necrosis after endoscopy: N Engl J Med, 2009; 361; e20

4.. Gupte AR, Draganov PV, Post-endoscopic retrograde cholangiopancreatography uvular necrosis: Clin Gastroenterol Hepatol, 2009; 7; A18

5.. Peghini PL, Salcedo JA, Al-Kawas FH, Traumatic uvulitis: A rare complication of upper GI endoscopy: Gastrointest Endosc, 2001; 53; 818-20

6.. Xiao M, Kaufman DI, Abrams GD, Uvular necrosis after shoulder surgery: a report of three cases: Cureus, 2021; 13; e14233

7.. Krantz MA, Solomon DL, Poulos JG, Uvular necrosis following endotracheal intubation: J Clin Anesth, 1994; 6; 139-41

8.. Harris MA, Kumar M, A rare complication of endotracheal intubation: Lancet, 1997; 350; 1820-21

9.. Iftikhar MH, Raziq FI, Laird-Fick H, Uvular necrosis as a cause of throat discomfort after endotracheal intubation: BMJ Case Rep, 2019; 12; e231227

10.. Calikapan GT, Karakus F, Uvula necrosis after endotracheal intubation for rhinoplasty: Aesthetic Plast Surg, 2008; 32; 710-11

In Press

Case report  Kosovo

A 74-Year-Old Man with Severe Comorbidities and Successful Abdominal Aortic Aneurysm Repair with Thoracic S...

Am J Case Rep In Press; DOI: 10.12659/AJCR.943702  


Case report  Vietnam

Fibrous Dysplasia of the Parietal Bone with Focal Motor Seizures: A Case Report

Am J Case Rep In Press; DOI: 10.12659/AJCR.943718  


Case report  Saudi Arabia

Regenerative Endodontic Procedure on an Immature Necrotic Molar: A Case Report with a 5-Year Review

Am J Case Rep In Press; DOI: 10.12659/AJCR.944179  

Case report  Italy

Minimally Invasive Surgical Management of Chronic Cough-Induced Rib Fracture Non-Union: A Case Report

Am J Case Rep In Press; DOI: 10.12659/AJCR.943222  

Most Viewed Current Articles

07 Mar 2024 : Case report  USA 38,465

Neurocysticercosis Presenting as Migraine in the United States

DOI :10.12659/AJCR.943133

Am J Case Rep 2024; 25:e943133


10 Jan 2022 : Case report  Germany 31,136

A Report on the First 7 Sequential Patients Treated Within the C-Reactive Protein Apheresis in COVID (CACOV...

DOI :10.12659/AJCR.935263

Am J Case Rep 2022; 23:e935263

19 Jul 2022 : Case report  Saudi Arabia 17,751

Atlantoaxial Subluxation Secondary to SARS-CoV-2 Infection: A Rare Orthopedic Complication from COVID-19

DOI :10.12659/AJCR.936128

Am J Case Rep 2022; 23:e936128

23 Feb 2022 : Case report  USA 17,750

Penile Necrosis Associated with Local Intravenous Injection of Cocaine

DOI :10.12659/AJCR.935250

Am J Case Rep 2022; 23:e935250

Your Privacy

We use cookies to ensure the functionality of our website, to personalize content and advertising, to provide social media features, and to analyze our traffic. If you allow us to do so, we also inform our social media, advertising and analysis partners about your use of our website, You can decise for yourself which categories you you want to deny or allow. Please note that based on your settings not all functionalities of the site are available. View our privacy policy.

American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923