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Gastric rupture after bag-mask-ventilation.
Stephan Bednarz1, Miodrag Filipovic1, Otto Schoch2
1Departement of Anesthesiology, Cantonal Hospital St. Gallen, Rorschacher Strasse 95, 9007 St. Gallen, Switzerland.
Respiratory Medicine Case Reports
|January 9, 2016
Summary
Forceful bag-mask ventilation during bronchoscopy can cause stomach rupture due to air insufflation. This rare complication highlights the risks of positive pressure ventilation in sedated patients.
Area of Science:
- Medical Procedures
- Gastroenterology
- Anesthesiology
Background:
- Bronchoscopy is a common procedure requiring sedation.
- Respiratory arrest can necessitate positive pressure ventilation.
- Complications from airway management during sedation are critical.
Observation:
- A patient undergoing bronchoscopy with propofol sedation experienced respiratory arrest.
- Bag-mask ventilation led to abdominal distention and high inspiratory pressures.
- Computed tomography revealed intraperitoneal free air, indicating a serious complication.
Findings:
- An emergent laparotomy confirmed a stomach rupture.
- Peak ventilatory pressures decreased immediately after the peritoneal cavity was opened.
- The case suggests forceful bag-mask ventilation caused gastric insufflation and rupture.
Implications:
- Clinicians must be aware of the potential for gastric barotrauma during positive pressure ventilation.
- Careful ventilation techniques are crucial to avoid iatrogenic injury in sedated patients.
- Prompt recognition and surgical intervention are vital for managing stomach rupture.