Tension pneumoperitoneum after bystander cardiopulmonary resuscitation: A case report

INTRODUCTION: Abdominal visceral injuries after cardiopulmonary resuscitation (CPR) are infrequent though can be significant complications of CPR requiring invasive interventions. We present a case of a gastric perforation as a result of bystander CPR. This resulted in tension pneumoperitoneum necessitating abdominal decompression prior to laparotomy and repair. PRESENTATION OF CASE: 37-year-old female complained of abdominal pain and distension after return of spontaneous circulation from successful CPR following a drug overdose and cardiopulmonary arrest. Abdominal imaging showed significant amounts of free intraperitoneal air causing compression of the abdominal visceral organs. Patient underwent exploratory laparotomy. Prior to induction of general anesthesia with potential cardiovascular collapse from the tension pneumoperitoneum, the abdomen was decompressed with a spring-loaded insufflation (Veress) needle while the patient was awake. Upon exploration, there were two three-centimeter gastric perforations that were primarily repaired with omental patch. The patient had an uneventful recovery and discharged home on postoperative day four. CONCLUSION: The Veress needle, usually used for insufflating the abdomen during laparoscopy, can also be an effective tool to decompress the abdomen when presented with tension pneumoperitoneum. Abdominal visceral injuries are rare following CPR but do occur and will likely require an invasive intervention. Surviving cardiac arrest as a young person and living without deficits outweighs the risk of a surgical correction for a visceral injury. While resuscitation measures are critical for survival, medical personnel need to be aware of potential complications from resuscitative efforts and potential management strategies.