Gastric Perforation Because of Non-Invasive Positive-Pressure Ventilation: Review of Complications

Abstract

Background: Non-invasive positive-pressure ventilation (NIPPV) is a useful tool, especially for patients with respiratory failure. Although NIPPV is accepted now as harmless and comfortable treatment tools for patients, the associated equipment can induce a critical illness if expiratory pressure is not adjusted adequately. Case: A 23-year-old male was admitted to our hospital complaining of severe abdominal pain. He had a history of congenital hypomyelination neuropathy. Because of respiratory insufficiency due to neuropathy, his doctor had prescribed NIPPV and increased end expiratory pressure three months earlier. Because abdominal computed tomography (CT) revealed ascites and pneumoperitoneum indicating gastrointestinal perforation, emergent laparotomy was performed. Intra-operative findings showed a gastric perforation and hematoma at the gastric anterior walls. The patient recovered from post-operative bowel obstruction and was transferred to pediatrics on post-admission day 26. Conclusion: Although gastrointestinal complications associated with NIPPV are rare, clinicians should be aware of possible life-threatening adverse events of the gastrointestinal rupture due to high respiratory pressure support.

Endoscopic Insufflation–Induced Gastric Barotrauma during Percutaneous Endoscopic Gastrostomy: A Report of Three Patients and Review of Literature

“…Aspirin and apixaban were discontinued 7 days and 3 days prior to PEG, respectively. Platelet count was 1.37 to 2.1 × 10 5 / mm 3 and INR (international normalized ratio) 1.1 to 1.24. There was no hiatus hernia and stomach lining was normal in all the three patients at the start of UGIE.…”

“…IGB has been reported following esophageal intubation during cardiopulmonary resuscitation (CPR), bag-mask ventilation, noninvasive positive pressure ventilation, use of oral sodium bicarbonate, and air swallowing during panic ascent in scuba diving. [1][2][3][4][5] IGB usually manifests as transmural perforation of the proximal stomach, requiring surgical intervention. Reports of endoscopy-induced gastric barotrauma J Digest Endosc 2021;12:103-106.…”