Tension gastrothorax

Case contributed by Dr Jayanth Keshavamurthy

Presentation

Status post robotic hiatal hernia repair. Desaturation to 84%. Left sided back pain.

Patient Data

Age: 65 years
Gender: Female

Chest x-ray

Large area of lucency occupying most of the lower portion of the left hemithorax. Airspace opacification in right lower zone.

Is this tension pneumothorax or not? What should you do next? What should you not do?

X-ray

Follow up chest x-rays

See individual descriptions for each chest x-ray below.

CT

CT thorax

  • Acute herniation of the gas and fluid distended fundus and body of the stomach into the left chest without evidence for volvulus or gastric ischaemia.
  • Associated compressive atelectasis left lower lobe and lingular segment left upper lobe, trace left pneumothorax and trace pleural fluid. Left chest tube in good position.
  • Trace right pneumothorax with moderate simple right pleural effusion and small to moderate dependent atelectasis.
  • Mesh appears to bulge through the gastro-oesophageal junction.
  • Nasogastric tube terminates in the distal esophagus, likely obstructed at the gastro-oesophageal junction by the herniated stomach.
X-ray

Post-operative chest x-ray

Finally repeat surgery and the stomach was brought back down into the abdomen, successfully.

Case Discussion

This is a rare complication of hiatus hernia surgery where the entire stomach migrated into the thorax and confused the clinical team who thought it was pneumothorax. Chest tubes did not work. OGD and NG tube placement confirmed the intra thoracic location of stomach. 

See also reference 4 below, well written similar case report.

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Case information

rID: 50945
Case created: 29th Jan 2017
Last edited: 11th Jun 2017
Inclusion in quiz mode: Included

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