Large area of lucency occupying most of the left hemithorax, with sparing of the apex. Airspace opacification in right lower zone. Acute intrathoracic left-sided gastric herniation, misdiagnosed as a pneumothorax.

Frontal: a left apical pleural pigtail catheter placed with no benefit.

Frontal : pigtail catheter removed and large bore chest tube is tried, also with no benefit.

Frontal: Dobhoff feeding tube is tried, curving towards the lucency in the left hemithorax.

Frontal: endoscopic guidance of enteric tube into stomach - x-ray shows that the lucency is in fact the stomach and not a pneumothorax.

• 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 segments left upper lobe, trace left pneumothorax and trace pleural fluid. Left chest tube in good position with small subcutaneous emphysema.
• Moderate simple right pleural effusion and small to moderate dependent atelectasis. Possible trace pneumothorax extreme right base.
• Mesh appears to bulge through the gastro-oesophageal junction.
• Nasogastric tube terminates in the distal oesophagus, likely obstructed at the gastro-oesophageal junction by the herniated stomach.

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