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Electrical cardioversion is recommended in atrial flutter or fibrillation and it is currently performed. Extracardiac severe complications are reported in the medical literature; however, the occurrence of gastric perforation complicating an electrical external cardioversion has not yet been reported. A 79 year old woman developed gastric perforation after a unique external shock of 200 J for cardioversion of an atrial fibrillation. Below left: abdominal and pelvic topogram in anterioposterior view. Note free peritoneal air delimiting the abdominal and pelvic lateral wall. Below right: computed tomographic axial plan at the level of the inferior renal pole. The small and large bowel are displaced posteriorly by the large air flap.
To our knowledge, this is the first reported case of gastric perforation after electrical cardioversion in the absence of any resuscitation process. Physicians must be aware that this procedure may lead to rare but sometimes serious extracardiac complications.