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American Journal of Critical Care. 2008;17: 388-390
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Cases of Note features peer-reviewed case reports and case series that document clinically relevant findings from critical and high acuity care environments. Cases that illuminate clinical diagnoses and management issues in the treatment of critically and acutely ill patients and include discussion of the patient’s experience with the illness or intervention are encouraged. Proposals for future Cases of Note articles may be e-mailed to ajcc{at}aacn.org.

Pneumoperitoneum Due to Gastric Perforation After Cardiopulmonary Resuscitation: Case Report

By CPT Christina D. Hahn, MD, MC, USA, LTC Yong U. Choi, MD, MC, USA, LTC Daniel Lee, DO, MC, USA and LTC James D. Frizzi, MD, MC, USA. Christina D. Hahn is a chief resident in general surgery, Yong U. Choi is chief of laparoscopic surgery, James D. Frizzi is chief of surgical critical care, and Daniel Lee is a pulmonary/critical care physician at Dwight D. Eisenhower Army Medical Center, Fort Gordon, Georgia.

Corresponding author: Yong U. Choi, MC, USA, General Surgery Service, Dwight D Eisenhower Army Medical Center, Fort Gordon, GA 30905 (e-mail: yong.u.choi{at}us.army.mil).

Background Pneumoperitoneum after cardiopulmonary resuscitation may be due to mediastinal air tracking into the peritoneal cavity via the diaphragmatic hiatus or to gastric perforation.

Case Report A 79-year-old woman received Advanced Cardiac Life Support measures in the intensive care unit. Chest compressions and endotracheal intubation were performed; a stable cardiac rhythm and perfusion were restored. A chest radiograph after resuscitation revealed pneumoperitoneum without pneumomediastinum. The patient underwent laparotomy; a 6-cm perforation of the posterior gastric wall along the lesser curve was detected and repaired.

Conclusion Gastric perforation after cardiopulmonary resuscitation should be suspected when chest radiographs obtained after resuscitation show pneumo-peritoneum without pneumomediastinum. Prompt laparotomy allows detection of gastric perforations and decreases the morbidity associated with rupture of a hollow organ. The incidence of gastric perforation after cardiopulmonary resuscitation may be decreased with early endotracheal intubation, avoidance of esophageal intubation, and expeditious placement of an orogastric tube.






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