Meet Sci. Law (1990) Vol. 30, No. 2
Printed in Great Britain
149
Gastric Trauma following Cardiopulmonary Resuscitation BOGDAN HULEWICZ, MB, ChB Lecturer in Forensic Pathology, Institute of Pathology, Royal Infirmary, Cardiff CF2 1SZ ABSTRACT
Three cases of gastric trauma following cardiopulmonary resuscitation are reported. In two cases there were Cull thickness lacerations of the gastric wall resulting in pneumoperitoneum and in one case subcutaneous emphysema. In the third case, gastric mucosal lacerations resulted in gastric haemorrhage. In all three cases it was thought that the gastric lesions did not contribute to death and were resuscitation artefacts.
The stomach contained a small volume of altered blood ('coffee grounds') and showed at least half a dozen mucosal lacerations (Figure 1), 2-3 cm below the gastro-oesophageal junction, along the lesser curvature. Some of these lacerations were full thickness, i.e. extending through the muscle layer and serosa. There were no oesophageal or duodenal lacerations.
INTRODUCTION Following the introduction of cardiopulmonary resuscitation (CPR) in the early sixties, numerous complications (resuscitation artefact) from this procedure have become well recognized. These include rib and sternal fractures, lacerations of the liver, spleen, lungs, heart and aorta, haemothorax and haemopericardium. Gastric trauma, in the form of gastric rupture or mucosal lacerations following cardiopulmonary resuscitation have also been described (Aguilar, 1981; Custer et aI., 1987; Demos and Poticha, 1964; McDonnell et al., 1984) but these complications are less well known amongst pathologists and clinicians. Their recognition and medico-legal importance is discussed. CASE NO. 1 A 59-year-old male was travelling to work by train when according to fellow passengers his 'head swelled up' and he collapsed and died. At autopsy there was evidence of subcutaneous emphysema of the face, neck and chest and the abdomen was visibly distended. There was no evidence of pneumothorax but when the abdomen was incised a gush of air was released.
Figure 1. Case No.1.
Full thickness linear gastric mucosal lacerations along the lesser curvature of the stomach.
150 Meet Sci. Law (1990) Vol. 30, No. 2
Figure2.. Case No.2. Superficial gastric mucosallacerations.
Figure 3. Case No.3. Fullthickness gastric rupture.
The coronary arteries showed severe atherosclerosis and the heart showed old ischaemic damage. Recognizing that the gastric lesions were resuscitation artefact, a request was made to the coroner's officer for a more detailed history. This revealed that the swelling of the deceased's head actually occurred during the administration of the 'kiss of life' by a fellow passenger and not prior to collapse as previously stated, i.e. a history of previously undescribed resuscitation and the correct sequence of events had been elicited.
second rib and a recent anterolateral fracture of the left fifth rib. The stomach contained approximately 100 ml of fresh and altered blood. Two mucosal lacerations approximately 2 em and 5.5 em in length were present on the lesser curvature approximately 4-5 cm below the gastro-oesophageal junction
Printed in Great Britain
149
Gastric Trauma following Cardiopulmonary Resuscitation BOGDAN HULEWICZ, MB, ChB Lecturer in Forensic Pathology, Institute of Pathology, Royal Infirmary, Cardiff CF2 1SZ ABSTRACT
Three cases of gastric trauma following cardiopulmonary resuscitation are reported. In two cases there were Cull thickness lacerations of the gastric wall resulting in pneumoperitoneum and in one case subcutaneous emphysema. In the third case, gastric mucosal lacerations resulted in gastric haemorrhage. In all three cases it was thought that the gastric lesions did not contribute to death and were resuscitation artefacts.
The stomach contained a small volume of altered blood ('coffee grounds') and showed at least half a dozen mucosal lacerations (Figure 1), 2-3 cm below the gastro-oesophageal junction, along the lesser curvature. Some of these lacerations were full thickness, i.e. extending through the muscle layer and serosa. There were no oesophageal or duodenal lacerations.
INTRODUCTION Following the introduction of cardiopulmonary resuscitation (CPR) in the early sixties, numerous complications (resuscitation artefact) from this procedure have become well recognized. These include rib and sternal fractures, lacerations of the liver, spleen, lungs, heart and aorta, haemothorax and haemopericardium. Gastric trauma, in the form of gastric rupture or mucosal lacerations following cardiopulmonary resuscitation have also been described (Aguilar, 1981; Custer et aI., 1987; Demos and Poticha, 1964; McDonnell et al., 1984) but these complications are less well known amongst pathologists and clinicians. Their recognition and medico-legal importance is discussed. CASE NO. 1 A 59-year-old male was travelling to work by train when according to fellow passengers his 'head swelled up' and he collapsed and died. At autopsy there was evidence of subcutaneous emphysema of the face, neck and chest and the abdomen was visibly distended. There was no evidence of pneumothorax but when the abdomen was incised a gush of air was released.
Figure 1. Case No.1.
Full thickness linear gastric mucosal lacerations along the lesser curvature of the stomach.
150 Meet Sci. Law (1990) Vol. 30, No. 2
Figure2.. Case No.2. Superficial gastric mucosallacerations.
Figure 3. Case No.3. Fullthickness gastric rupture.
The coronary arteries showed severe atherosclerosis and the heart showed old ischaemic damage. Recognizing that the gastric lesions were resuscitation artefact, a request was made to the coroner's officer for a more detailed history. This revealed that the swelling of the deceased's head actually occurred during the administration of the 'kiss of life' by a fellow passenger and not prior to collapse as previously stated, i.e. a history of previously undescribed resuscitation and the correct sequence of events had been elicited.
second rib and a recent anterolateral fracture of the left fifth rib. The stomach contained approximately 100 ml of fresh and altered blood. Two mucosal lacerations approximately 2 em and 5.5 em in length were present on the lesser curvature approximately 4-5 cm below the gastro-oesophageal junction
