Vol. 5 (2021): International Journal of Case Reports
Case Reports

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.


  • Pneumoperitoneum; Cardiopulmonary resuscitation; Bowel surgery; Anastomotic leak

How to Cite

Olivia A. Sacks, MD1,2, Priyanka Chugh, MD1,2, Katherine He, MD1,3, Allan Stolarski, MD1,2, Gentian Kristo, MD1,3*. (2021). Intestinal anastomosis blowout following post-operative cardiopulmonary resuscitation: A case report. International Journal of Case Reports, 5, 190. https://doi.org/10.28933/ijcr-2020-12-1005


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.


  1. Sommers MS. Potential for injury: trauma after cardiopulmonary resuscitation. Heart Lung. 1991;20(3):287-293.
  2. Beom JH, You JS, Kim MJ, et al. Investigation of complications secondary to chest compres-sions before and after the 2010 cardiopulmonary resuscitation guideline changes by using mul-ti-detector computed tomography: a retrospec-tive study. Scand J Trauma Resusc Emerg Med. 2017;25(1):8.
  3. Meron G, Kurkciyan I, Sterz F, et al. Cardio-pulmonary resuscitation-associated major liver injury. Resuscitation. 2007;75(3):445–453.
  4. Lundqvist J, Jakobsson JG. Pulmonary emboli cardiac arrest with CPR complication: Liver lac-eration and massive abdominal bleed, a case report. International Journal of Surgery Case Reports. 2017;31: 24–26.
  5. Spoormans I, Van Hoorenbeeck K, Balliu L, Jorens PG. Gastric perforation after cardiopul- monary resuscitation: Review of the literature. Resuscitation. 2010;81(3):272–280.
  6. Aziz M. Traumatic Pancreatitis: A Rare Compli-cation of Cardiopulmonary Resuscitation. Cu-reus. 2017;9:e1574.
  7. Deras P, Manzanera J, Millet I, et al. Fatal pan-creatic injury due to trauma after successful cardiopulmonary resuscitation with automatic mechanical chest compression. Anesthesiolo-gy. 2014;120(4):1038–1041.
  8. Bernard SA, Jones BM, Scott WJ. Intra-abdominal complications following prolonged cardiopulmonary resuscitation. Aust N Z J Surg. 1993;63(4):312-314.
  9. Koutserimpas C, Ioannidis A, Siaperas P, et al. Intra-Abdominal Hemorrhage following Car- diopulmonary Resuscitation: A Report of Two Cases. Case Rep Emerg Med. 2018;2018: 5243105-5243105.
  10. Yamaguchi R, Makino Y, Chiba F, et al. Frequency and influencing factors of cardio- pulmonary resuscitation-related injuries during implementation of the American Heart Association 2010 Guidelines: a retrospective study based on autopsy and postmortem computed tomography. Int J Legal Med. 2017;131(6):1655-1663.
  11. Hartoko TJ, Demey HE, Rogiers PE, et al. Pneumoperitoneum — a rare complication of cardiopulmonary resuscitation. Acta Anaesthe- siologica Scandinavica. 1991;35(3):235-237.
  12. Atcheson SG, Peterson GV, Fred HL. Ill effects of cardiac resuscitation: Report of two unusual cases. Chest 1975;67:61.5-616.
  13. Gordon HL. Walkup JL. Scrotal pneumotocele as an unusual sign of pneumoperitoneum: Re-port of a case and review of the literature. J Urol 1970;104:441-442.
  14. Clinch SL, Thompson JS, Edney JA. Pneu-moperitoneum after cardiopulmonary resuscita-tion: A therapeutic dilemma. J Trauma 1983; 23:428-430.
  15. Gainant A, Gobeaux R, Renaudie J. Pneu-moperitoneum secondary to cardiopulmonary resuscitation. Presse Med 1984;13:1845-1846.
  16. Hargarten KM, Aprahamian C, Mateer J. Pneu-moperitoneum as a complication of cardio-pulmonary resuscitation. Am J Emerg Med 1988;6:358-361.
  17. Keverian T, Bose S. Pneumoperitoneum after Cardiopulmonary Resuscitation. Anesthesiology. 2019;130(1):153-153.
  18. Khan A, Merrett N, Selvendran S. Stomach perforation post cardiopulmonary resuscita-tion-A case report. Int J Surg Case Rep. 2017;40:43-46.
  19. Milanchi S. Approach to pneumoperitoneum after cardiopulmonary resuscitation. J Trauma. 2006;61:1552–1553.
  20. Offerman SR, Holmes JF, Wisner DH, Gastric rupture and massive pneumoperitoneum after bystander cardiopulmonary resuscitation, J. Emerg.Med. 2001;21:137–139.
  21. Henneman PL, Marx JA, Moore EE, et al. Di-agnostic peritoneal lavage: accuracy in pre-dicting necessary laparotomy following blunt and penetrating trauma. J Trauma. 1990 Nov;30(11): 1345-55.