Gastric mucosal laceration: a complication of manual bag-valve-mask ventilation

A 73-year-old woman was admitted to our hospital because of severe myocardial infarction. After intratracheal intubation, cardiac catheterization was performed. Thereafter, a nasogastric tube was also inserted to reduce marked gastric distension. Immediately, massive fresh blood was observed from the nasogastric tube, and her blood pressure rapidly went down. Emergent upper gastrointestinal endoscopy demonstrated a bleeding mucosal laceration along the lesser curvature of the stomach, and the laceration was treated endoscopically. Previous autopsy series suggest that gastric lacerations may occur in 2-12% of cases that receive cardiopulmonary resuscitation, but there have been no reports observed and treated endoscopically. Attention to the technique of ventilation may help to minimize the incidence of gastric mucosal lacerations during the peri-resuscitation period. Because hemorrhage from gastric mucosal lacerations may be a source of secondary morbidity or even mortality, evidence of upper gastrointestinal bleeding peri-intubation should be approached aggressively.