An 81‐year‐old frail man (weight 99 lb) with a medical history significant for chronic obstructive pulmonary disease, lower‐extremity deep venous thrombosis (on warfarin), hypertension, and recent left hip replacement was undergoing rehabilitation and had a witnessed aspiration episode requiring the Heimlich maneuver. The foreign body was successfully expelled with resumption of spontaneous respirations. Several hours later, he developed bilateral lower extremity weakness and numbness, with loss of femoral artery pulses bilaterally. Computed tomography revealed complete occlusion of the infra‐renal abdominal aorta and the inferior mesenteric artery as well as right‐sided pulmonary emboli. He underwent an emergent aortogram with administration of an intra‐arterial bolus of tissue plasminogen activator followed by a continuous infusion of this agent. Although he regained lower extremity pulses, he progressively declined, culminating in multiorgan failure, and he died after being terminally weaned from mechanical ventilation. An autopsy revealed severe ulcerative atherosclerosis of the aorta with extensive plaques from the arch through its entire length. There was an infrarenal aortic thrombus that occluded 60% of the lumen.
The Heimlich maneuver is effective in relieving upper airway obstruction from a foreign body. Complications associated with this procedure can involve intrathoracic or intra‐abdominal viscera, but they are infrequent. Few case reports of acute abdominal aortic thrombosis following the Heimlich maneuver have been reported in the literature. Performance of the Heimlich maneuver in this case likely caused rupture of atherosclerotic plaque in the abdominal aorta with resultant aortic thrombosis, a rare but recognized event.
Although severe complications of the Heimlich maneuver are uncommon, it is important that hospitalists considerthem in the appropriate clinical setting. Prompt diagnosis and intervention may improve the clinical outcomes.
S. Shojaee, None; J. Akong, None; T. Martin, None; R. Bobba, None; M. Kazemi, None.