Tension gastrothorax in late-onset congenital diaphragmatic hernia, a rare but life-threatening condition

Abstract

Rationale: Tension gastrothorax is a serious condition that can cause acute respiratory failure, which is mostly related to congenital diaphragmatic hernia (CDH) in pediatric cases. It is uncommon in late-onset CDH patients, and is difficult to diagnose due to atypical presentation. It is often misdiagnosed as tension pneumothorax or pleural effusion, leading to delayed treatment and potentially fatal outcome. In this study, we are reporting our experience of diagnosis and treatment of tension gastrothorax in a late-onset CDH patient. Patient concerns: A 2-year old boy presented to this hospital with severe dyspnea and abdominal pain that suddenly occurred while taking a bath. Diagnosis: Based on radiological findings we diagnosed tension gastrothorax. Interventions: Hernia reduction and diaphragmatic defect repair were performed under thoracotomy. Outcomes: After the operation, the patient's clinical symptoms and imaging findings improved. At 1-year postoperative follow up, the patient was well with normal chest x-ray findings. Lessons: Tension gastrothorax in late-onset CDH is a life-threatening condition that requires rapid diagnosis and treatment. When the diagnosis is unclear by chest x-ray, chest computed tomography should be performed to confirm the diagnosis. A nasogastric tube should be inserted whenever possible for diagnosis and gastric decompression. Although laparotomy is the most preferred approach, we recommend that surgeons consider taking a thoracotomy approach in unstable patients that cannot undergo gastric decompression before operation.

Study on Influencing Factors Analysis of Gastric Tube Insertion Length and Construction of Estimation Method

“…Therefore, although there are many studies on the estimation method of the insertion length of gastric tube in China and abroad, their views have not yet been unified. The lengths of gastric tube recommended by different institutes were different, and the common clinical values include 45-55 cm, 55-65 cm, 55-68 cm, and 55-70 cm (6)(7)(8). In addition, the commonly used body surface measurement methods for the length of gastric tube in clinic include the length from nasal tip to earlobe to xiphoid process (NEX), the length from nasal tip to earlobe to navel to the midpoint of xiphoid process (NEMU), the length from hairline to xiphoid process (FX), the length from hairline to navel (FU), and the length from hairline to navel to the midpoint of xiphoid process (FMU) (9)(10)(11)(12).…”

Comparison of the incidence of intrathoracic stomach in Bochdalek's hernia detected by imaging with that detected by surgery

“…Nevertheless, after the gastric hernia entered the chest cavity, the stomach cannot easily returned to the abdominal cavity due to the small diaphragmatic defect and stomach distension. Some patients may even had acute obstruction or perforation due to gastric torsion [22,23] .…”

Unmasking a hidden culprit: late-presenting congenital diaphragmatic hernia beyond infancy: A case report and literature review

“…Project administration: Wen-Harn Koh. [12] 108 Boy Respiratory distress, chest pain + Naess et al [13] 9 Boy Respiratory distress, irritable high-pitched cry Pelech et al [14] 24 Boy respiratory distress, abdominal pain Song et al [15] 96 Boy respiratory distress, chest pain, nonbilious vomiting Anekar et al [9] 10 Boy Respiratory distress + García et al [16] 144 Boy Respiratory distress Fuller et al [17] 18 Girl Abdominal pain + Hooker et al [18] 53 Boy Respiratory distress + Guo et al [19] 72 Boy Respiratory distress + Guo et al [19] 28 Boy Respiratory distress + Guo et al [19] 156 Girl Respiratory distress, chest pain, vomiting + Rathinam et al [20] 120 Boy Respiratory distress, epigastric pain, vomiting + Ahn et al [21] 9 Boy Respiratory distress + Sridhar et al [22] 29 Boy Respiratory distress + Snyder et al [23] 2 Girl Respiratory distress, excessive crying, irritability + Al Ghafri et al [24] 35 Girl Abdominal pain + This article NG tube = Nasogastric tube…”