Excessive stomach inflation causing gut ischaemia

An 18 years old male was found after a fall unconscious, but pontaneously breathing, 80min−1 sinus rhythm, 125/73mmHg rterial blood pressure, and an arterial oxygen saturation of 98%. he patient was anaesthetised and intubated, but became asysolic during hospital transfer. In the hospital an oesophageally laced tracheal tube was detected, and the position was corrected. eturn of spontaneous circulation ensued after cardiopulmonary esuscitation with 1mg epinephrine. Amassively dilated abdomen as diagnosed (Figure 1). Multi-organ failure developed and CT can revealed severe progressive cerebral oedema; intensive care upport was withdrawn. The patient died ∼36h after the fall, as reviously reported.1 Excessive stomach inflation may occur with undetected esophageal intubation, causing massive dilation of the abdomen, ompromising ventilation even after tube position is corrected.2 tomach inflation may also trigger intestinal rupture,3 or reguritation and aspiration that may result in pneumonia. Recently, stomach inflation-triggered abdominal compartment syndrome as been reported.4 In this patient autopsy revealed multiple tears n the oesophagus and extensive necrosis in the colon which ay be indicative of stomach inflation-triggered (1) high intrauminal pressure, (2) intestinal hypo-perfusion, and (3) severe gut schaemia. While ventilatory compromise, intestinal rupture, and ulmonary aspiration are well known complications of stomach nflation, gut ischaemia may have been insufficiently realised.