ABSTRACT Pregnant women are more prone to trauma in cardiopulmonary resuscitation (CPR) like bronchial fracture, rib fracture and tension pneumothorax. This is a unique case of diaphragmatic injury caused during CPR with simultaneous Tension pneumothorax with Tension pneumoperitoneum, which could have been fatal unless immediately managed. A 32-year-old unbooked, uninvestigated woman presented with term pregnancy and eclampsia. She suffered cardiopulmonary arrest twice and was revived both times. After the second CPR, she developed tension pneumothorax and tension pneumoperitoneum. They were released with prompt placement of chest tubes and laparoscope. A small defect in the diaphragm, sealed with a blood clot was found and therefore was left as such. Further cardiopulmonary collapse was thus prevented. During CPR, sudden complications like inability to ventilate and decreased air entry should alert the clinician about the possibility of a pneumothorax. A sudden visible tension pneumoperitoneum after a CPR should alert the remote possibility of coexistent pneumothorax and pneumoperitoneum through a diaphragmatic rupture. A prompt multidisciplinary team is required for immediate diagnosis and management.
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