# Gastric Perforation and Peritonitis Following Barium Swallow in a Patient With Prior Mechanical Ventilation and Stress Ulcer Prophylaxis: A Rare but Critical Complication

## TL;DR

A rare case of gastric perforation occurred in a critically ill patient despite receiving standard GI prophylaxis and a normal barium swallow test.

## Contribution

This case report highlights the rare but critical complication of gastric perforation in patients on mechanical ventilation and stress ulcer prophylaxis.

## Key findings

- A 65-year-old male developed gastric perforation after a negative barium swallow while on pantoprazole and mechanical ventilation.
- Emergency surgery confirmed an anterior gastric ulcer perforation with purulent peritonitis.
- The patient was successfully treated with surgical washout and antibiotics and was discharged stable.

## Abstract

Gastric perforation is a serious yet rare complication in critically ill patients on mechanical ventilation and GI prophylaxis. This report highlights an unexpected gastric perforation in a patient with a negative barium swallow study while receiving GI prophylaxis during intubation. A 65‐year‐old male with COPD and tobacco use disorder was treated with Oseltamivir for Influenza A infection, intubated for acute respiratory failure, and received IV pantoprazole for GI prophylaxis. After extubation and an unremarkable barium swallow study, he developed abdominal pain and tachycardia. Imaging showed free air under the diaphragm, and a CT scan indicated gastrointestinal perforation. Emergency surgery confirmed an anterior gastric ulcer perforation with purulent peritonitis. He was successfully treated with a washout and antibiotics and was discharged in stable condition. This case underscores the necessity of vigilance for abdominal symptoms and the potential for gastric perforation in critically ill patients despite GI prophylaxis, highlighting the importance of recognizing early signs of pneumoperitoneum.