Acute presentation of congenital diaphragmatic hernia past the neonatal period: a life threatening emergency

Tension gastrothorax

“…Tension gastrothorax is particularly likely to occur if belching or vomiting is hampered by the abnormally angulated gastroesophageal junction, and if there is gastric outlet obstruction caused by tension, distorsion, and possibly pyloric spasm [6]. The mediastinal shift caused by tension gastrothorax can be so massive that cardiac arrest results [5,7,9]. Of note, this happened in 2 of our 5 cases (Cases 2 and 5), one of which survived because it occurred in the emergency room.…”

“…In fact, only approximately 10% of patients with CDH present after the age of 5 months, and the proportion of those developing tension gastrothorax is presumably very small [1,2]. Of note, clinical presentation of late-onset CDH encompasses a wide spectrum ranging from nonspecific symptoms, such as coughing, fever, chest pain, abdominal pain, diarrhea, and failure to thrive, to acute gastrointestinal obstruction or sudden and massive respiratory distress and eventually cardiac arrest which are characteristic for tension gastrothorax [1][2][3][4][5][6][7]. In the latter, like in our patients (Cases 1-4), physical examination reveals tachypnea, cyanosis, diminished breath sounds, and eventually bowel sounds in the chest.…”

“…Approximately 10% of patients with CDH present later, and their prognosis is far better because of absence of significant pulmonary hypoplasia and hypertension [1,2]. The clinical presentation of late-onset CDH encompasses a wide spectrum ranging from nonspecific symptoms (recurrent pulmonary infection, chest pain, abdominal pain, and failure to thrive) to respiratory distress and cardiac arrest caused by massive distension of the intrathoracic stomach, that is, tension gastrothorax [1][2][3][4][5][6][7]. Interestingly, the term tension gastrothorax first appeared in the literature in 1984 as a complication of traumatic rupture of the diaphragm [8].…”

Die Magenperforation als akute Komplikation einer unerkannten Zwerchfellhernie

“…Zur Diagnosesicherung können gelegentlich Kontrastmitteldarstellungen des Intestinums hilfreich sein. Bei Patienten mit akuter respiratorischer oder kardiozirkulärer Insuffizienz ist wegen der intrathorakalen Raumforderung durch den luftgefüllten Magen die Dekompression durch eine nasal eingebrachte Magensonde die entscheidende Maûnahme [12].…”

Tension gastrothorax: a case report and review of literature

“…The presentation varies from nonspecific symptoms (recurrent pulmonary infection, chest pain, abdominal pain, and failure to thrive) to respiratory distress and cardiac arrest caused by massive distension of the intrathoracic stomach, that is, tension gastrothorax [2,4,8,9]. The term tension gastrothorax first appeared in the literature in 1984 as a complication of traumatic rupture of the diaphragm [10].…”