Abstract
A 39-year-old man was found while he had been lying in cardiac arrest at the bottom of a swimming pool. Following cardiopulmonary resuscitation performed by a by-stander, his heart beat regained. When he arrived at our hospital, the blood pressure was 255/107, pulse rate was 137/min, the SpO2 was 70%, and massive intraoral bleeding and abdominal distension were noted. An abdominal CT scan showed large volumes of free air in the abdominal cavity and bloody discharge was observed from a gastric tube. Gastrointestinal perforation was thus diagnosed and an emergency laparotomy was performed. Upon laparotomy, we observed air retention in the lesser omentum, a dilated stomach which was also filled with air and clotts, and an about 7cm-long laceration on the gastric wall extending from the esophagogastric junction to the lesser curvature of the stomach. The laceration was closed by sutures. After the operation the patient was associated with acute respiratory failure, but he was discharged from the hospital on his feet on the 30th postoperative day.
Gastric dilatation due to inappropriate ventilation at cardiopulmonary resuscitation can cause an abrupt rise of the intragastric pressure by oppressing the sternum, with a resultant high risk of developing rupture of the stomach. Appropriate ventilation and sternum oppression are mandatory. When the patient develops gastrointestinal perforation in a state of return of spontaneous circulation (ROSC), emergency laparotomy must be carried out as soon as possible by keeping a possibility of gastric rupture in mind.
