Gastric Emphysema after Intubation

A 72-year-old male with history of psychiatric disorders was referred to our emergency department in a state of cardiac arrest after a suicide attempt. The patient had attempted suicide by a knife of 30 cm in length. He reported a deep wound to the left side of the neck, together with superficial abdominal wounds. During transportation to the hospital, the patient was orally intubated and cardio-pulmonary resuscitation and fluids were administered with restoration of hemodynamic profile. After arrival, he was stabilized by fluid treatment and blood transfusions. Once stabilized and while ventilated, decision was taken to perform thoracic-abdominal multiphasic contrast-enhanced CT examination to assess further traumatic damages. At the preliminary digital tomogram, a thin, linear area of increased radiolucency that outlines the gastric wall was imaged in the upper left abdominal region (Figure 1, arrow). At CT scan, gastric intramural gas was clearly detected (Figures 2, 3, coronal reformatted and axial images, arrows); furthermore a small amount of retroperitoneal free air was seen around splenic vein and diaphragmatic crura (Figure 3). The diagnosis of gastric emphysema due to mild mucosal disruption was concluded. The most likely explanation of the mucosal trauma was an excess of pressure inside the stomach caused by the attempts of intubation in the ambulance and some air insufflation in the esophageal lumen. The patient was managed conservatively and his condition slowly recovered during the following days.