Pneumoperitoneum Following Cardiopulmonary Resuscitation in a Dog

A 14-year-old intact female mongrel dog presented for periodontal disease underwent anesthesia for dental procedures. During surgery, the dog developed cardiopulmonary arrest (CPA) characterized by a sudden drop in end-tidal carbon dioxide and pulseless electrical activity. Cardiopulmonary resuscitation was initiated and return of spontaneous circulation was achieved after 20 min. Post-resuscitation imaging revealed moderate pneumoperitoneum, hepatic portal venous gas, and gas within the caudal vena cava without evidence of gastrointestinal rupture or peritonitis. Conservative management including intensive monitoring and supportive care resulted in progressive resolution of these gas accumulations and complete clinical recovery. This is the first veterinary report to describe pneumoperitoneum following CPR during dental surgery. The case broadens current understanding of nonsurgical etiologies of pneumoperitoneum in small animals and demonstrates that conservative management may be a viable option in selected post-resuscitation patients.