title: Pneumoperitoneum due to gastric perforation after cardiopulmonary resuscitation: case report.
abstract: BACKGROUND
  Pneumoperitoneum after cardiopulmonary resuscitation may be due to mediastinal air tracking into the peritoneal cavity via the diaphragmatic hiatus or to gastric perforation.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: General Surgery, Dwight D. Eisenhower Army Medical Center, Fort Gordon, Georgia 30905, USA.
authors.forename: Christina D
authors.initials: CD
authors.lastname: Hahn
authors.forename: Yong U
authors.initials: YU
authors.lastname: Choi
authors.forename: Daniel
authors.initials: D
authors.lastname: Lee
authors.forename: James D
authors.initials: JD
authors.lastname: Frizzi
mesh_terms: D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D011027:Pneumoperitoneum / Q000209:etiology* / Q000601:surgery; D013270:Stomach / Q000293:injuries*