Anestesia e Pesquisa Clínica
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Gastric Rupture after Bag Mask Ventilation: A Review Under a Case Report

Marta Carvalho, Pedro Godinho, Andreia Moura, Carla Silva, Isabel Tourais, Margarida Marques and Humberto S Machado

Introduction: Bag mask ventilation is considered a safe and effective ventilation method. Despite the high frequency of gastric distension, few cases of gastric rupture are reported in literature. Case report: A 50-year-old female firefighter, ASA 2, was admitted in to the Burn Unit due to 2nd/3rd grade burns (34% of body surface). On the 22nd day after admission, she underwent balneotherapy, under sedation and analgesia and in spontaneous ventilation. During the procedure, desaturation (SpO2 65%) and paradoxical respiratory abdominal movements were noticed. Very high pressures were immediately required for bag-mask ventilation and the bag was difficult to compress. A remarkable increase in abdominal perimeter was evident, leading to the compromise of lower limb circulation. The patient was intubated and a noradrenaline infusion started due to marked hypotension, unresponsive to fluids. Imaging studies revealed a left pulmonary atelectasis and a massive pneumoperitoneum. Emergent exploratory laparotomy demonstrated a gastric laceration in an ischemic mucosa area, which was corrected. The patient was extubated on the first post-operative day, with no further complications. Conclusion: Although bag mask ventilation is a routine practice, it is associated with several complications. Gastric rupture is an extreme rare complication of this technique. The higher incidence of curling ulcers in burned patients may have contributed to gastric rupture and this case stresses the need to consider this potentially lethal complication.