An 85-year-old male with hypertension, hypertensive heart disease, chronic atrial fibrillation, transient ischemic attack without sequelae and recurrent respiratory infections and bronchoaspiration.
Intervention of a subcapital fracture after correction of coagulation 72 hours.
After 24 hours she presented respiratory distress and decreased level of consciousness secondary to pulmonary infiltrate, with improvement after antibiotic therapy.
96 hours after surgery, the patient developed sudden abdominal pain, vomiting and dyspnoea.
Abdominal radiography: air in the entire greater curvature of the stomach.
Urgent abdominal computed tomography: diffuse extension gastric circumferential intramural gas and towards the lower esophageal third, with a small amount of pneumoperitoneum adjacent to the lesser curvature, portal venous gas and pneumomediastinum findings compatible with esophagus.
Treatment with broad-spectrum intravenous antibiotics, parenteral nutrition, proton pump inhibitors and nasogastric tube.
An ischemic etiology was ruled out on computed tomography angiography: absence of arterial repletion defects.
Computed tomography at 11 days: disappearance of gastroesophageal pneumatosis; complete collapse of the left lung.
Urgent resolving bronchoscopy: aspiration of mucus plugs.
Antibiotic therapy was suspended after 14 days starting oral tolerance satisfactorily.
At 96 hours, the patient has a bronchoaspiration, clinical and respiratory worsening, dying at 24 hours.
