Food Particle Aspiration Associated with Hemorrhagic Shock: A Diagnostic Dilemma

Abstract

The hemodynamic compromise caused by a large aspirated food particle in the airway can become the focus of medical attention and a distraction from rare but fatal Heimlich maneuver related injuries after an incident of food aspiration. We herein present a case of an 84-year-old man who was brought to the emergency department after an episode of choking at a restaurant followed by several failed Heimlich maneuver attempts. Despite relieving the airway obstruction by extracting a large piece of steak from the airway, the patient remained hypotensive and required continued hemodynamic support. Repeated laboratory tests within 24 hrs of aspiration showed a significant decline in the hemoglobin level. A computed tomography (CT) scan of the abdomen and pelvis showed a lacerated liver with a large subcapsular hematoma draining into the pelvis. Conclusion. Hepatic rupture is a rare complication of Heimlich maneuver; this paper represents the second case report in the literature. It emphasizes the necessity of early identification and surveillance of fatal Heimlich maneuver complications in a high risk population.

Figure 1

Flow/Time curve on the mechanical ventilator showing auto-PEEP with a notched expiratory flow curve appearing as an “inverted square root sign” (arrows); this represents a complete occlusion of the airway during expiration when the point of equalization of pressures reaches the level of airway obstruction.

Figure 2

Chest X-ray. Inflated lungs with right upper lobe opacity and a high endotracheal tube position caused by a foreign body in the central airway.

Figure 3

A large piece of steak removed from the trachea with rigid bronchoscopy, approximately 10 cm long.

Figure 4

CT abdomen and pelvis. (a) Coronal view and (b) axial view, showing a liver laceration with a large subcapsular hematoma and hemoperitoneum.