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

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

Olivia A. Sacks, MD1,2, Priyanka Chugh, MD1,2, Katherine He, MD1,3, Allan Stolarski, MD1,2, Gentian Kristo, MD1,3*

1Department of Surgery, Veterans Affairs Boston Healthcare System, Boston, MA, USA; 2Department of Sur¬gery, Boston Medical Center, Boston University Medical School, Boston, MA, USA; 3Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA.

Background: Pneumoperitoneum following cardiopulmonary resuscitation (CPR) is a very rare complication with a challenging management. In this paper we describe the management of a patient who suffered a blowout of his colorectal anastomosis after undergoing CPR for a cardiac arrest in the early post-operative period. Additionally, we present a thorough literature review of the management of CPR-related pneumoperitoneum.

Summary: Five days after a sigmoid resection for colon cancer, a 71-year-old male went into pulseless electrical activity and CPR was initiated, with complete clinical recovery. After CPR the patient was found to have new hydropneumothorax and pneumoperitoneum. Because he had a normal abdominal examination, lack of leukocytosis, and no evidence of a bowel perforation on water-soluble CT imaging, the patient was initially managed non-operatively with close clinical follow-up. However, he failed the non-operative management and ultimately required a laparotomy demonstrating a blowout of his colonic anastomosis.

Conclusion: Physicians should remain aware of the risk of damage to fresh bowel anastomoses following CPR. There should be a low threshold for surgical exploration in patients that develop CPR-related pneumoperitoneum soon after intestinal surgery, even when patient’s clinical status is stable.

Keywords: Pneumoperitoneum; Cardiopulmonary resuscitation; Bowel surgery; Anastomotic leak

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How to cite this article:

Olivia A. Sacks, Priyanka Chugh, Katherine He, Allan Stolarski, Gentian Kristo. Intestinal anastomosis blowout following post-operative cardiopulmonary resuscitation: A case report. International Journal of Case Reports, 2021; 5:190. DOI: 10.28933/ijcr-2020-12-1005


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