Background: Bag mask ventilation is a safe and effective method frequently used. 1 Despite the frequent occurrence of gastric distension, there are few reports of gastric rupture and pneumoperitoneum.2 Case report: A 50-year-old female patient, ASA 2, was admitted on Burn Unit due to 2nd/3rd grade burns in 34% of body surface caused by fire. On the 22nd day after admission, she underwent balneotherapy under sedoanalgesia in spontaneous ventilation. During the procedure, desaturation (SpO2 65%) and paradoxical respiratory movements were noticed and bag mask ventilation was started with an increase airway resistance perceived. At this time, a remarkable increase in abdominal perimeter was observed, leading to a compromised of lower limb circulation. Tracheal intubation was performed and mechanical ventilation started, as noradrenaline infusion due to marked hypotension. Imagiologic study revealed left pulmonary atelectasis and pneumoperitoneum (Figure 1). An emergent exploratory laparotomy demonstrated a gastric laceration in an ischemic mucosa area. The patient was extubated on the 1st postoperative day with no complications. Discussion: Although bag mask ventilation is a routine practice, it is associated with several complications. Gastric rupture is a rare complication of this technique. The higher incidence of Curling ulcers in burned patients can definitely have contributed to gastric rupture and this case stresses the need to consider this potentially lethal complication. Learning points: Gastric rupture is a rare, but potential life-threatening complication of bag mask ventilation. When associated with hemodynamic instability it requires immediate intervention. We should always keep our standards of care even for minor procedures outside the operating room and be aware for complications occurrence. 
References:1-Gastric rupture following bag-valve-mask ventilation, The Journal of Emergency Medicine, Vol 22, Issue 1, Jan 2002, Pages 27–29 |2-Gastric Rupture With Tension Pneumoperitoneum: A Complication of Difficult Endotracheal Intubation, Annals of Emergency Medicine, Vol 30, Issue 3, Sept1997, Pages 343–34

Panic at the balneotherapy room - a case of gastric rupture after bag mask ventilation