EUSEM: A case of esophageal rupture following the Heimlich maneuver.
as presented at the annual congress of the European Society for Emergency Medicine
At EUSEM, held in September-October in Amsterdam, members of the Emergency Department (ED) at University College Hospital in Galway, Ireland, presented the case history of a 73-year-old lady who presented following a choking episode.
She had been eating a chicken curry when she began to choke on a bolus of rice. Family members administered the Heimlich maneuver, after which she coughed up the rice. Shortly after presenting to the ED she decided to leave without further assessment; she was feeling much better and tolerated water.
But eight hours later she returned with severe epigastric pain and nausea. On arrival she was pale, clammy, tachycardic, and initially hypotensive. Arterial blood gas measurement showed lactic acidosis. Chest x-ray showed bilateral pleural effusions. There was high clinical suspicion of a perforated viscus and so she had a contrast CT of her thorax. This revealed rupture to the mid-third of the esophagus, 12 cm from the gastroesophageal junction, with associated pneumomediastinum, a right-sided pleural effusion, and right-sided apical pneumothorax.
A right-sided chest drain was inserted and the perforation was stented endoscopically. Following a short hospital stay she went on to make a full recovery.
According to the study authors, “Although it is often a life-saving technique, the Heimlich itself can cause life-threatening injuries. As far as we can determine, esophageal rupture has been described twice previously in the literature as a complication of the Heimlich maneuver.”
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