Intra-Abdominal Hemorrhage following Cardiopulmonary Resuscitation: A Report of Two Cases

Abstract

Cardiopulmonary resuscitation (CPR) represents an emergency procedure, consisting of chest compressions and artificial ventilation. Two rare cases of intra-abdominal bleeding following cardiac compressions are reported. The first case was a 29-year-old female with massive pulmonary embolism (PE). Following CPR due to cardiac arrest, she showed signs of intra-abdominal bleeding. A liver laceration was found and sutured. The patient passed away, due to massive PE. The second patient was a 62-year-old female, suffering from cardiac arrest due to drowning at sea. CPR was performed in situ. At presentation to the emergency department she showed signs of intra-abdominal bleeding. The origin of the hemorrhage was found to be vessels of the lesser curvature of the stomach, which were ligated. Regarding the first patient PE has already been described as a cause for liver lacerations in CPR due to stasis and liver enlargement. The second case is the first report of gastric vessel injury without gastric rupture/laceration and pneumoperitoneum. Complications of CPR should not represent a drawback to performing cardiac compressions. Parenchymatic injuries have been related to inappropriate technique of chest compressions during basic life support. Therefore, it is of utmost importance for the providers to refresh their knowledge of performing CPR.

Optimal chest compression position for cardiopulmonary resuscitation determined by computed tomography image: retrospective cross-sectional analysis

“…Potentially lethal complications to abdominal organ such as laceration of liver, spleen and stomach were also reported at the recommended compression site 15 , 16 . However, it appears that there have been few case reports of intraabdominal organ injury during CPR, despite the fact that a significant portion of the liver and stomach is positioned in the lower region of the sternum 17 , 18 .…”

Intestinal anastomosis blowout following post-operative cardiopulmonary resuscitation: A case report

“…Primary pneumoperitoneum after CPR results from perforations of the gastrointestinal tract, most commonly the esophagus and stomach [8] . During CPR, air can track from the esophagus to the stomach secondary to chest compressions or ventilation, increasing gastric pressure causing mucosal tears or, more rarely, perforation [9] . In most cases, perforations occur in the lesser curvature of the stomach near the gastro-esophageal junction.…”

<p>Hemoperitoneum After Cardiopulmonary Resuscitation in Peritoneal Dialysis Patients: A Tale of Two Cases</p>

“…Koutserimpas et al reported two cases of hemoperitoneum following CPR. 10 The first included a 29-year-old female who had a massive pulmonary embolism and developed left hepatic lobe laceration (5 cm) because of CPR. The second patient was a 62-year-old female that developed cardiac arrest after drowning.…”