Tension pneumoperitoneum complicating gastric rupture following cardiopulmonary resuscitation

Gastric rupture with tension pneumoperitoneum (TP) is a rare surgical complication of cardiopulmonary resuscitation (CPR). We present a case of TP after an untrained lay rescuer provided chest compression. A 63-year-old woman with history of depression was found unresponsive after she consumed antidepressant drugs. The duration of compression only CPR was 7 minutes. On arrival to the emergency department, femoral pulsation was not palpable. Subcutaneous emphysema was palpable in both shoulder and neck area. Abdomen was massively distended, rigid, tympanic and hyper-resonant to percussion. Chest radiography revealed massive air collection in abdominal cavity and TP was diagnosed. Immediate percutaneousgaged needle decompression of the peritoneum with an 18-gaged catheter was attempted. After needle decompression, haemodynamic instability was restored. She underwent exploratory laparotomy and multiple gastric perforations were found and repaired. This case highlights both high index of suspicion and prompt decompression of TP is needed for gastric rupture complicating bystander CPR.