CLINICAL COMMUNICATION TO THE EDITOR
Gastric Perforation after Heimlich Maneuver To the Editor: The Heimlich maneuver is life-saving in a patient choked by a foreign body.1 However, rare complications have been reported following this maneuver, even when it was performed properly. Herein, we present a case of gastric perforation following a forceful Heimlich maneuver in a patient with nasopharyngeal cancer. A 59-year-old woman suffered from airway obstruction while she was eating breakfast, with immediate loss of consciousness. She had a medical history of nasopharyngeal cancer and had undergone radiotherapy. She had subsequent impaired swallowing function and was easily choked. Upon arrival, an emergency medical technician (EMT) attempted the Heimlich maneuver several times in order to relieve the airway obstruction. The attempt failed, however, and the patient suffered sudden cardiac arrest. The EMT then started cardiopulmonary resuscitation immediately, and the patient was transported to our Emergency Department. There, food debris that obstructed the airway of the patient was removed by instruments. After endotracheal intubation and further resuscitation, return of spontaneous circulation was noted with recovery of consciousness. The patient’s chest radiography then showed massive subphrenic free air (Figure). Thus, an exploratory laparotomy was performed due to suspicion of hollow organ perforation. Several tears of the gastric wall were identified and repaired. The postoperative course was favorable, and the patient was discharged uneventfully 10 days later.
DISCUSSION The Heimlich maneuver was first described in 1974, and thereafter, this simple procedure has saved many lives by relieving airway obstruction.1 However, complications such as rib fracture, diaphragm rupture, pneumomediastinum, acute thrombosis of abdominal aortic aneurysm, mesenteric laceration, and traumatic injury of the gastrointestinal tract also have been reported after the Heimlich maneuver.2-7 Gastric perforation is another rare but lifeFunding: None. Conflict of Interest: None. Authorship: All authors had access to the data and played a role in writing this manuscript. Requests for reprints should be addressed to Chih-Cheng Lai, Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan. E-mail address:
[email protected]
0002-9343/$ -see front matter © 2012 Elsevier Inc. All rights reserved.
Figure Chest radiography shows free air under the diaphragm.
threatening complication of this maneuver.8 In our case, the gastric perforation was possibly caused by the multiple abdominal thrusts attempted. Physicians should be aware of this rare complication of the Heimlich maneuver in order to have an early diagnosis and prompt management.
Chien-Ming Chao, MD Chih-Cheng Lai, MD Department of Intensive Care Medicine Chi Mei Medical Center Liouying, Tainan, Taiwan
Che-Kim Tan, MD Department of Intensive Care Medicine Chi Mei Medical Center Yongkang, Tainan, Taiwan
http://dx.doi.org/10.1016/j.amjmed.2012.02.008
e8
The American Journal of Medicine, Vol 125, No 6, June 2012
References 1. Heimlich HJ. A life saving maneuver to prevent food-choking. JAMA. 1975;234:398-401. 2. Haynes DE, Haynes BE, Yong YV. Esophageal rupture complicating Heimlich maneuver. Am J Emerg Med. 1984;2:507-509. 3. Chapman JH, Menapace FJ, Howell RR. Rupture aortic valve cusp: a complication of the Heimlich maneuver. Ann Emerg Med. 1983; 12:446-448. 4. Kirshner RL, Green RM. Acute thrombosis of abdominal aortic aneu
5. 6. 7. 8.
rysm subsequent to Heimlich maneuver: a case report. J Vasc Surg. 1985;2:594-596. Agla GA, Hurst DJ. Pneumoperitoneum following the Heimlich maneuver. JACEP. 1979;8:473-475. Valero V. Mesenteric laceration complicating a Heimlich maneuver. Ann Emerg Med. 1986;15:105-106. Ujjin V, Ratanasit S, Nagendran T. Diaphragmatic hernia as a complication of the Heimlich maneuver. Int Surg. 1984;69:175-176. Fearing NM, Harrison PB. Complications of the Heimlich maneuver: case report and literature review. J Trauma. 2002;53:978-979.