Gastric perforation following cardiopulmonary resuscitation

Excerpt

A 52-year-old woman with a history of hypertension and depression was found hanging on the porch by her boyfriend. She was taken down, and the boyfriend started cardiopulmonary resuscitation (CPR). The patient achieved a return of spontaneous circulation on emergency medical services arrival. The patient was not able to protect her airway, hence was intubated. Vital signs were stable. Gastric distension was noted on physical examination. A nasogastric tube was inserted to decompress the distension. Portable chest X-ray (Fig. 1a) was done showing pneumoperitoneum. To further evaluate, non-contrast-enhanced computer tomography (CT) of the chest, abdomen, and pelvis was done to evaluate the gastric distension refractory to nasogastric tube insertion. CT of the chest, abdomen, and pelvis (Fig. 1b, c) showed large volume pneumoperitoneum compressing on the abdominal viscera. Following this finding emergent surgical consult was made. The patient was taken to surgery. Exploratory laparotomy showed gastric perforation at the level of lesser curvature of the stomach, and partial gastrectomy was done. The patient recovered adequately after surgery and was discharge for rehabilitation. Gastric perforation was attributed to aggressive chest compression leading to impingement of stomach between xiphoid and spine with forceful mouth to mouth breathing with wrong airway positioning.

…