Tension gastrothorax complicating post-traumatic rupture of the diaphragm

Ordog, Gary J.; Wasserberger, Jonathan; Balasubramaniam, Subramaniam

doi:10.1016/0735-6757(84)90008-1

Cited by 25 publications

(20 citation statements)

References 7 publications

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“…Tension gastrothorax describes mediastinal shift by a distended intrathoracic stomach herniated through a congenital or acquired diaphragmatic defect [ 1 – 3 ]. Most pediatric cases are left-sided and the stomach has herniated through a congenital posterolateral (Bochdalek) defect [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

“…It develops when the stomach herniated through a left-sided diaphragmatic defect into the thorax is massively distended by trapped air and/or fluid. The term tension gastrothorax first appeared in the literature in 1984 as a complication of traumatic rupture of the diaphragm in an adult [ 1 ]. However, in childhood this phenomenon is dominantly caused by a herniation of the stomach through a posterolateral congenital diaphragmatic defect [ 2 – 4 ].…”

Section: Introductionmentioning

confidence: 99%

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Tension gastrothorax: acute life-threatening manifestation of late onset congenital diaphragmatic hernia (CDH) in children

Næss

Wiborg

Kjellevold

et al. 2015

Scand J Trauma Resusc Emerg Med

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Tension gastrothorax in children is a life-threatening condition and presents dramatically with acute and severe respiratory distress. It develops when an intra-thoracic stomach herniated through a diaphragmatic defect is massively distended by trapped air and/or fluid causing mediastinal displacement. Tension gastrothorax is often misinterpreted as tension pneumothorax and managed as such leading to increased morbidity and mortality. We present a child with tension gastrothorax and a literature review of this phenomenon.Immediate clinical and radiographic evaluation should lead to accurate diagnosis followed by emergency decompression of the stomach before laparotomy with reduction of herniated viscera and repair of the diaphragmatic defect.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Tension gastrothorax: acute life-threatening manifestation of late onset congenital diaphragmatic hernia (CDH) in children

Næss

Wiborg

Kjellevold

et al. 2015

Scand J Trauma Resusc Emerg Med

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“…The first description of tension gastrothorax was reported by Ordog et al in 1984 [ 1 ]. They described that a distended stomach in the thoracic cavity through the site of a diaphragm rupture can lead to mediastinum shift.…”

Section: Introductionmentioning

confidence: 99%

How to manage tension gastrothorax: a case report of tension gastrothorax with multiple trauma due to traumatic diaphragmatic rupture

et al. 2017

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BackgroundTension gastrothorax is a kind of obstructive shock with prolapse and distention of the stomach into the thoracic cavity. Progressive gastric distension leads to mediastinal shift, reduced venous return, decreased cardiac output, and ultimately cardiac arrest. Therefore, it is crucial to decompress the stomach distension for the initial resuscitation of tension gastrothorax.Case presentationA 75-year-old female was transported to our resuscitation bay due to motor vehicle crash. At the time of arrival to our hospital, the patient developed cardiac arrest. While undergoing cardiopulmonary resuscitation, an unstable pelvic ring was recognized, so we performed a resuscitative thoracotomy to control hemorrhage and to perform direct cardiac massage. Once we performed the thoracotomy, the stomach and omentum prolapsed out of the thoracotomy site and through the diaphragm rupture site and spontaneous circulation was recovered. Neither the descending aorta nor the heart was collapsed. Although we had continued the treatment for severe pelvic fracture (including blood transufusions), the patient died. Given that (1) the stomach prolapsed out of the body at the time of the thoracotomy; (2) at the same timing, spontaneous circulation returned; and (3) the descending aorta and heart did not collapse, we hypothesized that the main cause of the initial cardiac arrest was tension gastrothorax.ConclusionsRecognition of tension gastrothorax pathophysiology, which is a form of obstructive shock, makes it possible to manage this injury correctly.

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“…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]. Since then, a small number of reports of late-onset CDH presenting with tension gastrothorax appeared in literature (Table 1).…”

mentioning

confidence: 97%