2012 Volume 19 Issue 2 Pages 225-229
A 39-year-old man suffered from cardiac arrest due to drowning in a swimming pool after drinking and eating. Bystander-initiated cardiopulmonary resuscitation (CPR) including mouth-to-mouth ventilation was performed for approximately 2 min, which restored his spontaneous circulation and breathing at the scene. On arrival at our hospital, abdominal distension, hematemesis, and tracheal obstruction due to the aspiration of gastric contents were observed. Chest CT scan revealed reticulonodular infiltrates and ground-glass opacity with a gravitational density gradient in the bilateral lung fields, suggestive of acute respiratory distress syndrome (ARDS) associated with drowning. Abdominal CT image revealed gastric dilatation and massive pneumoperitoneum. A diagnosis of upper gastrointestinal perforation, most likely due to the bystander-initiated CPR was made, and an emergency laparotomy was performed. A longitudinal laceration approximately 7 cm in length was found from the right anterior wall of the abdominal esophagus to the lesser curvature of the stomach, and was repaired. Although the postoperative respiratory management of ARDS required considerable effort, the trachea was extubated on the 9th day after admission, and discharged from the hospital on the 30th day, without any neurological sequelae. We consider that the reduction in the lung compliance associated with diffuse lung injury and/or the increase in airway resistance associated with tracheal obstruction, combined with the preceding gastric distension by drinking and eating, could facilitate gastric insufflation during the mouth-to-mouth ventilation, and eventually resulted in gastric perforation despite the brief duration of CPR.
