Acute post-traumatic tension gastrothorax, a tension pneumothorax-like injury

Abstract

Diaphragmatic rupture is an uncommon and frequently missed complication in blunt thoraco-abdominal trauma. Symptoms usually become apparent in a delayed phase, up to years after the trauma. An acute presentation is extremely rare and acute tension gastrothorax in which trapping of air in the intrathoracic stomach causes mediastinal shift and lung compression, as in tension pneumothorax, is exceptional. We only found two cases in the literature. We present here two other cases from our practice, with a review on the literature on post-traumatic diaphragmatic hernias.

Tension Gastrothorax Complicating Third Trimester of Pregnancy: Suspicion is the Key

“…Subsequent distension of the stomach or intestine in the chest may cause respiratory distress, mediastinal shift, and hemodynamic compromise leading to tension gastrothorax. [1]…”

“…[57] Placement of NGT minimizes the chance of tension gastrothorax. [1] As the patient was extremely dyspnoeic, uncooperative, and period of gestation was more than 32 weeks, we decided to perform elective LSCS after steroid therapy. [8] All the preparations for thoracotomy were completed before caesarean section.…”

“…Pressure exerted by the growing uterus may cause herniation of abdominal organs such as stomach, spleen, intestine, etc., into the thoracic cavity through a defect in the diaphragm. [12] This defect may be inherent to the diaphragm or caused by rupture of it. Distension of the hernial content can lead to respiratory or cardiac compromise.…”

A prehospital paediatric tension viscerothorax presenting as a tension pneumothorax: a diagnostic dilemma

“…Some authors state that in ruptured diaphragm a gastric tube should be passed as it will decompress and relieve symptoms;10 however, this may be impossible due to anatomical changes with the intrathoracic placement of the stomach 11…”

Gastrothorax or tension pneumothorax: A diagnostic dilemma

“…This may result from air swallowing in respiratory distress or insufflation of air during bag mask ventilation or gastroscopy. [5] This was avoided in the first place because a NGT was already inside the stomach. How did the NGT manage to camouflage is also important in this case?…”