Ventilation-induced gastric rupture after extubation in the ICU: a case report

Gastric rupture is a rare yet potentially fatal complication that has been reported during cardiopulmonary resuscitation (CPR). This is generally attributed to acute gastric overdistension caused by chest compressions combined with positive-pressure ventilation. Ventilation-induced gastric rupture after planned extubation in the intensive care unit (ICU) is rare.

An 80-year-old man developed acute gastric rupture shortly after planned ICU extubation following lumbar spinal surgery. Quantitative neuromuscular monitoring was not performed prior to extubation. Four minutes after extubation, repeated bag-mask ventilation and laryngeal mask airway-assisted ventilation were administered prior to successful reintubation. Progressive abdominal distension was observed during rescue ventilation. Imaging demonstrated massive pneumoperitoneum, while emergency surgery identified a 5-cm longitudinal perforation along the lesser curvature of the stomach without evidence of ischemic discoloration. No CPR was conducted. The patient required prolonged mechanical ventilation and died 2 months later from progressive nosocomial pneumonia.

Repeated positive-pressure ventilation after ICU extubation may result in gastric rupture even in the absence of CPR. Awareness of progressive abdominal distension, objective neuromuscular assessments before extubation and careful control of inspiratory pressure may improve airway safety in high-risk patients.