A case of gastric rupture due to cardiopulmonary resuscitation

• Published in: Nihon Kyukyu Igakukai Zasshi 2013/02/15, Vol.24(2), pp.94-98
• Main Authors: Ozaki, Yoshimi, Shibata, Shunsuke, Nishidoi, Hideaki
• Format: Article
• Language: eng ; jpn
• Subjects: chest compression; lesser curvature of stomach; pneumoperitoneum
• ISSN: 0915-924X; 1883-3772
• DOI: 10.3893/jjaam.24.94

A 71-year-old female had cardiopulmonary arrest after aspirating confectionery products. Immediate cardiopulmonary resuscitation (CPR) using a bag valve mask and chest compression resulted in resumption of respiration and heartbeat after 10 minutes. The patient was transported to our hospital because of altered consciousness. Her abdomen was distended. Plain X-ray revealed right subphrenic free air. Computed tomography revealed large amount of free intra-abdominal air. We suspected gastrointestinal perforation and performed emergency laparotomy. The lesser curvature of the stomach was red, with small air bubbles in the serosa. An incision was made in the anterior stomach wall, confirming a 7 cm gastric mucosal laceration. Although we confirmed that the laceration did not penetrate all gastric wall layers, a small part of it was presumed to have caused intra-abdominal air accumulation. We performed abdominal lavage and inserted a drain. The patient improved postoperatively and was transferred to a different hospital after 16 days. During CPR, the risk of gastric rupture increases because of gastric dilation during chest compression and inappropriate ventilation. Furthermore, if abdominal distension or signs of peritonitis are observed when heartbeat resumes, gastric rupture should be suspected and rapidly diagnosed by preoperative imaging. And it is important that laparotomy is performed immediately.