A life‐threatening complication of a life‐saving manoeuvre

Clinical presentation

An 80‐year‐old woman had airway obstruction while eating dinner at home. She became rapidly cyanotic and then unresponsive. A family member performed the Heimlich manoeuvre, which resulted in a successful dislodgement of the offending morsel. The patient then vomited a large amount of red blood and remained unconscious. Within an hour, she was transported to our emergency department.

Her medical history was unremarkable. Physical examination showed low blood pressure (blood pressure 95/75 mm Hg), tachycardia (heart beat 115/min) and pale conjunctiva. Her breath sounds were clear and the abdomen was soft. Laboratory examinations showed anaemia (haemoglobin concentration 6.4 g/dl, mean corpuscular volume 82 fl) and normal coagulation profiles. An urgent CT was arranged after fluid resuscitation (fig 1).

Figure 1 Contrast‐enhanced emergent CT showing lesions (arrow) in the stomach.

Question

What is the diagnosis?

See page 372 for answer