Gastric Perforation due to Noninvasive Positive-pressure Ventilation

Background: Noninvasive positive-pressure ventilation (NIPPV) is a useful tool, especially for patients with respiratory failure. Although NIPPV is now accepted as harmless and comfortable treatment tools for patients, the associated equipment can induce a critical illness if expiratory pressure is not adjusted adequately.Case: A 23-year-old man was admitted to our hospital complaining of severe abdominal pain. He had a history of congenital hypomyelination neuropathy. Because of respiratory insufficiency due to neuropathy, his doctor had prescribed NIPPV and increased end expiratory pressure three months earlier. Since abdominal computed tomography revealed ascites and pneumoperitoneum indicating gastrointestinal perforation, emergent laparotomy was performed. Intraoperative findings showed a gastric perforation and hematoma at the gastric anterior walls. The patient recovered from postoperative bowel obstruction and was transferred to pediatrics on post admission day 26. Conclusion: Although gastrointestinal complications associated with NIPPV are rare, clinicians should be aware of possible life-threatening adverse events of the gastrointestinal rupture due to high respiratory pressure support.