Gastric rupture following cardiopulmonary resuscitation: case report - Critical Care Science (CCS)

BACKGROUND AND OBJECTIVES: Gastric rupture is a rare complication from cardiopulmonary resuscitation (CPR), with a reported incidence of 0.1%. Unawareness of this possible complication during these maneuvers delays its recognition and reduces the patient’s surviving chance. The aim of this report is to describe a case of acute abdomen due to gastric rupture following CPR maneuvers that was promptly diagnosed and treated. CASE REPORT: We report a case of a 76-year-old patient that was admitted to the hospital with pneumonia and also to rule out a possible brain vascular accident (BVA). In the first day after admission she developed acute respiratory failure and cardiac arrest, being successfully resuscitated and subsequently transferred to the intensive care unit (ICU) by the medical ward team. Despite successful CPR, adequate volume resuscitation, vasopressor support and respiratory function improvement she remained with significant hemodynamic instability. Physical examination hours after CPR showed a hypertimpanic liver percussion, abdominal distension, tachycardia and hypotension. Chest X-Ray revealed pneumoperitoneum, and gastric perforation was identified by an exploratory laparotomy. Histopathology confirmed traumatic gastric injury. CONCLUSIONS: We report a rare case of traumatic gastric rupture after CPR maneuvers in which prompt diagnosis and emergent treatment lead to a favorable outcome. This case brings out the need to increase awareness of this life-threatening complication with emphasis on the importance of a thorough physical examination after CPR maneuvers. Reinforcement of appropriate CPR technique is crucial to avoid incorrect maneuvers through continued medical education.